Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations

A randomized clinical trial

Steven L. Mansberger, Christina Sheppler, Gordon Barker, Stuart K. Gardiner, Shaban Demirel, Kathleen Wooten, Thomas Becker

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

IMPORTANCE: Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations. OBJECTIVE: To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. DESIGN, SETTING, AND PARTICIPANTS: From August1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. MAINOUTCOMESANDMEASURES: Percentage of participants receiving annual diabetic retinopathy screening examinations, percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from stage 0 (none) to stage 4 (proliferative diabetic retinopathy), and percentage of telemedicine participants who would require referral to an eye care professional for follow-up care using a cutoff of moderate diabetic retinopathy or worse, the presence of macular edema, or an unable-to-determine result for retinopathy or macular edema. RESULTS: The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less (94.6% [280/296] vs 43.9% [119/271]; 95% CI, 46.6%-54.8%; P

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalJAMA Ophthalmology
Volume133
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Telemedicine
Diabetic Retinopathy
Randomized Controlled Trials
Macular Edema
Aftercare
Primary Health Care
Referral and Consultation

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)

Cite this

Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations : A randomized clinical trial. / Mansberger, Steven L.; Sheppler, Christina; Barker, Gordon; Gardiner, Stuart K.; Demirel, Shaban; Wooten, Kathleen; Becker, Thomas.

In: JAMA Ophthalmology, Vol. 133, No. 5, 01.05.2015, p. 518-525.

Research output: Contribution to journalArticle

Mansberger, Steven L. ; Sheppler, Christina ; Barker, Gordon ; Gardiner, Stuart K. ; Demirel, Shaban ; Wooten, Kathleen ; Becker, Thomas. / Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations : A randomized clinical trial. In: JAMA Ophthalmology. 2015 ; Vol. 133, No. 5. pp. 518-525.
@article{cf38a16a060c4cd28f3ba5b5d1f0e3ba,
title = "Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: A randomized clinical trial",
abstract = "IMPORTANCE: Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations. OBJECTIVE: To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. DESIGN, SETTING, AND PARTICIPANTS: From August1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. MAINOUTCOMESANDMEASURES: Percentage of participants receiving annual diabetic retinopathy screening examinations, percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from stage 0 (none) to stage 4 (proliferative diabetic retinopathy), and percentage of telemedicine participants who would require referral to an eye care professional for follow-up care using a cutoff of moderate diabetic retinopathy or worse, the presence of macular edema, or an unable-to-determine result for retinopathy or macular edema. RESULTS: The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less (94.6{\%} [280/296] vs 43.9{\%} [119/271]; 95{\%} CI, 46.6{\%}-54.8{\%}; P",
author = "Mansberger, {Steven L.} and Christina Sheppler and Gordon Barker and Gardiner, {Stuart K.} and Shaban Demirel and Kathleen Wooten and Thomas Becker",
year = "2015",
month = "5",
day = "1",
doi = "10.1001/jamaophthalmol.2015.1",
language = "English (US)",
volume = "133",
pages = "518--525",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "5",

}

TY - JOUR

T1 - Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations

T2 - A randomized clinical trial

AU - Mansberger, Steven L.

AU - Sheppler, Christina

AU - Barker, Gordon

AU - Gardiner, Stuart K.

AU - Demirel, Shaban

AU - Wooten, Kathleen

AU - Becker, Thomas

PY - 2015/5/1

Y1 - 2015/5/1

N2 - IMPORTANCE: Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations. OBJECTIVE: To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. DESIGN, SETTING, AND PARTICIPANTS: From August1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. MAINOUTCOMESANDMEASURES: Percentage of participants receiving annual diabetic retinopathy screening examinations, percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from stage 0 (none) to stage 4 (proliferative diabetic retinopathy), and percentage of telemedicine participants who would require referral to an eye care professional for follow-up care using a cutoff of moderate diabetic retinopathy or worse, the presence of macular edema, or an unable-to-determine result for retinopathy or macular edema. RESULTS: The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less (94.6% [280/296] vs 43.9% [119/271]; 95% CI, 46.6%-54.8%; P

AB - IMPORTANCE: Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations. OBJECTIVE: To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. DESIGN, SETTING, AND PARTICIPANTS: From August1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. MAINOUTCOMESANDMEASURES: Percentage of participants receiving annual diabetic retinopathy screening examinations, percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from stage 0 (none) to stage 4 (proliferative diabetic retinopathy), and percentage of telemedicine participants who would require referral to an eye care professional for follow-up care using a cutoff of moderate diabetic retinopathy or worse, the presence of macular edema, or an unable-to-determine result for retinopathy or macular edema. RESULTS: The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less (94.6% [280/296] vs 43.9% [119/271]; 95% CI, 46.6%-54.8%; P

UR - http://www.scopus.com/inward/record.url?scp=84929665466&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929665466&partnerID=8YFLogxK

U2 - 10.1001/jamaophthalmol.2015.1

DO - 10.1001/jamaophthalmol.2015.1

M3 - Article

VL - 133

SP - 518

EP - 525

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 5

ER -