AAO 2024: Teleretinal screening for diabetic eye disease

Christina Y Weng, MD, MBA sat down to discuss the Retina Ophthalmic Technology Assessment Symposium and her journal on teleretinal screening for diabetic eye disease at this year's American Academy of Ophthalmology meeting held in Chicago, Illinois.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Sydney M Crago:

Hi, I'm Sydney Crego with Ophthalmology Times and Modern Retina, and I'm here today with Dr Christina Weng to talk a little bit about her upcoming presentation at the AAO meeting in Chicago. Dr Weng, you will be presenting the use of teleretinal screenings for diabetic retinopathy. Can you tell us about what this presentation will entail?

Christina Y Weng, MD, MBA:

Of course, thank you for having me. Sydney. Good to be back. At this year's Academy meeting in Chicago, I was honored to be part of the Retina OTA [Ophthalmic Technology Assessment] Symposium, which was led by my friend and colleague, Dr Leo Kim, who chairs the retina Ophthalmic Technology Assessment Committee. And these OTA committees are composed of academy members from various subspecialties that evaluate drugs, procedures, and diagnostic tests for clinical effectiveness and safety. And these data syntheses undergo rigorous grading and review by both internal and external parties prior to publication.

I recently published an OTA in the Blue Journal with my committee members focusing on teleretinal screening for diabetic eye disease. And appreciate the opportunity to provide sort of a high level overview of our work today. So Sydney, the impetus behind the concept of teleretinal screening really originates from the fact that diabetic retinopathy is largely preventable with timely detection. But very unfortunately, only about 50-65% of patients with diabetes mellitus are actually compliant with these screening recommendations, and in fact, this rate is even lower for ethnic minorities. Now the reasons behind these subpar numbers are multifactorial, but they include limited access to care, lack of patient awareness, and of course, socioeconomic disparities. And the way that teleretinal screening helps to address these is by lessening the distance between the patient and their care. We know that patients with diabetes visit their primary care provider a lot more frequently, usually around 3 to 4 times per year, on average, than they do their ophthalmologist. Who they may see, you know, 1 time a year–if even. Right? So therefore, teleretinal screening programs are often set up in the primary care setting, and are typically based on non-mediatic fundus camera images that are then interpreted either synchronously or asynchronously. Depending on the level of disease, interpreted from the images the patient may be asked to either return for a repeat screening in the future or to present for an in clinic examination for diagnostic confirmation and treatment.

Now, multiple programs like this exist around the world, and in fact, I'm part of a large teleretinal screening program here in Houston, which has screened nearly 200,000 eyes to date. It's been really extremely effective in terms of identifying and treating patients with visually threatening disease who otherwise would not have received care. We've also published quite a bit on the program's impact on screening compliance as well as its cost effectiveness. So while we do have a sense that teleretinal screening is beneficial, we wanted to assess it a bit more objectively.

So this OTA aims to identify data published between 2006 and 2023 focused on the effectiveness of teleretinal screening. Which was defined in one of three ways. The first was accuracy in detecting diabetic retinopathy or diabetic macular edema compared with traditional ophthalmic screening with dilated fundoscopic examination or 7 standard field ETDRS photography. The second way that we evaluated effectiveness was the impact on diabetic retinopathy screening compliance rates. And the third was through cost effectiveness and patient satisfaction of teleretinal screening compared with traditional diabetic retinopathy screening.

We ended up identifying 372 citations, of which 37 were abstracted, and categorized into 8 level 1 studies, 14 level 2 studies and 2 level 3 studies. And I'll direct you to our Blue Journal publication from August 2024 for the synopses of those studies. But broadly, what we found was 4 points. The first was that teleretinal screening demonstrated acceptable sensitivity and good specificity in detecting diabetic retinopathy. The second was that teleretinal screening was not as robust in detecting diabetic macular edema. Third was that teleretinal screening had a positive impact on overall diabetic retinopathy screening compliance, increasing it by more than 2-fold in 1 study. And the last point was that teleretinal screening was cost effective and well received by patients, with many preferring it over traditional surveillance methods.

And certainly there are limitations to this type of assessment, given differences in the reference standards and program characteristics, but this OTA supports that teleretinal screening for diabetic retinopathy has multiple benefits. Including the capacity to increase screening large populations, offering a cost effective and patient friendly approach to screening, and then improving access to care and screening compliance–potentially preventing vision loss. And our hope is that this work will encourage confidence in similar diabetic retinopathy teleretinal screening programs, and also provide a foundation for future work as these programs become more robust, more prevalent and more technologically sophisticated.