Telemedicine Screening of the Prevalence of Diabetic Retinopathy Among Type 2 Diabetic Filipinos in the Community
Jessica Daza, Jocelyn Sy, Maria Victoria Rondaris, John Philip Uy
Oct 2022 DOI 10.35460/2546-1621.2022-0024 Access
Purpose: To determine the feasibility of telemedicine screening for diabetic retinopathy in a community setting and to determine the prevalence of diabetic retinopathy among Filipino patients with type 2 diabetes in the community.
Study Design: Cross-sectional study among patients with type 2 diabetes in six community health centers in an urban city in the Philippines.
Materials and methods: Subjects were examined from November 2018 to December 2018. A three-field non-mydriatic 45’ fundus photographs were taken for each patient and photographs were uploaded in cloud storage and read by a retina specialist in a tertiary hospital for assessment of diabetic retinopathy and grading of the fundus photographs. The results were sent back to local health centers.
Results: A total of 387 eyes of 195 persons were examined. Overall, 288 out of 387 eyes (95.36%) had gradable quality fundus photo (grade 3 and higher) and did not need eye dilation. Prevalence of diabetic retinopathy among the respondents was 25.26% - 3.16% had mild diabetic retinopathy, 15.79% had moderate diabetic retinopathy, 3.68% had severe diabetic retinopathy, and 3.68% had proliferative diabetic retinopathy. Other fundus findings noted include hypertensive retinopathy glaucomatous optic nerve, age-related macular degeneration, posterior vitreous detachment, clinically significant macular edema, and epiretinal membrane.
Conclusion: Due to the significant number of patients with diabetic retinopathy among type 2 diabetics in the community, telemedicine screening was a feasible alternative to dilated fundus examination and may be considered as part of the local health program to prevent blindness due to diabetes.
Key Words: diabetes, diabetic retinopathy, telemedicine, tele-ophthalmology, community screening
- IDF Diabetes Atlas, 8th ed. Brussels, Belgium: International Diabetes Federation, 2017. [cited 2018 Dec 8]. Available from: http://www.diabetesatlas.org
- Tan GH. Diabetes care in the Philippines. Ann Glob Health [Internet]. 2015;81(6):863–9. Available from: http://dx.doi.org/10.1016/j.aogh.2015.10.004
- Global Reports on Diabetes. World Health Organization. 2016. [cited 2018 Dec 8]. Available from: http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf
- Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol [Internet]. 2012;60(5):428–31. Available from: http://dx.doi.org/10.4103/0301-4738.100542
- Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care [Internet]. 2012;35(3):556–64. Available from: http://dx.doi.org/10.2337/dc11-1909
- Silva P, Cavallerano J, Paz-Pacheco E, Aiello L. Diabetic retinopathy in southeast Asia: A call for ocular telehealth programs. Journal of ASEAN Federation of Endocrine Societies. 2012;27(2). [cited 2018 Dec 8]. Available from: https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/33
- Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298:902-16. [cited 2018 Dec 8]. Available from: https://jamanetwork.com/journals/jama/fullarticle/208502. doi:10.1001/jama.298.8.902
- Updated 2017 ICO Guidelines for Diabetic Eye Care. International Council of Ophthalmology. 2017. [cited 2018 Dec 8]. Available from: http://www.icoph.org/downloads/ICOGuidelinesforDiabeticEyeCare.pdf
- Telemedicine 2010. World Health Organization. 2010. [cited 2018 Dec 8]. Available from: http://www.who.int/goe/publications/goe_telemedicine_2010.pdf
- Sreelatha OK, Ramesh SV. Teleophthalmology: improving patient outcomes? Clin Ophthalmol. [Internet]. 2016;10:285–95. Available from: http://dx.doi.org/10.2147/OPTH.S80487
- Tayapad J, Bengzon A, Valero S, Arroyo M, Papa R, Fortuna E, et al. Implementation and pilot data on diabetic retinopathy in a teleophthalmology program at a multispecialty primary care clinic. Philippine Journal of Ophthalmology. 2014, July-December. 2014;39:90-3. Available from: https://paojournal.com/article/implementation-and-pilot-data-on-diabetic-retinopathy-in-a-teleophthalmology-program-at-a-multispecialty-primary-care-clinic/
- Bursell SE, Cavallerano JD, Cavallerano AA, Clermont AC, Birkmire-Peters D, Aiello LP, et al. Stereo nonmydriatic digital-video color retinal imaging compared with early treatment diabetic retinopathy study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy. Ophthalmology [Internet]. 2001;108(3):572–85. Available from: http://dx.doi.org/10.1016/s0161-6420(00)00604-7
- Lamirel C, Bruce BB, Wright DW, Delaney KP, Newman NJ, Biousse V. Quality of nonmydriatic digital fundus photography obtained by nurse practitioners in the emergency department: the FOTO-ED study. Ophthalmology [Internet]. 2012;119(3):617–24. Available from: http://dx.doi.org/10.1016/j.ophtha.2011.09.013
- Chun DW, Bauer RM, Ward TP, Dick JSB II, Bower KS. Evaluation of digital fundus images as a diagnostic method for surveillance of diabetic retinopathy. Mil Med [Internet]. 2007;172(4):405–10. Available from: http://dx.doi.org/10.7205/milmed.172.4.405
- Carandang G, Rondaris MV, Adarlo G. Use of eye care services among type 2 diabetic patients in Laguna. Philippine Journal of Ophthalmology. 2016;41:39–44. [cited 2018 Dec 8]. Available from: https://paojournal.com/article/use-of-eye-care-services-among-type-2-diabetic-patients-in-laguna/
- Fajardo-Gomez MF, Uy H. Prevalence of diabetic retinopathy among diabetics in a tertiary hospital. Philippine Journal of Ophthalmology. 2005;30(4):178–80. [cited 2018 Dec 8]. Available from: https://paojournal.com/article/prevalence-of-diabetic-retinopathy-among-diabetic-patients-in-a-tertiary-hospital/
- Gosheva M, Klameth C, Norrenberg L, Clin L, Dietter J, Haq W, et al. Quality and learning curve of handheld versus stand-alone non-mydriatic cameras. Clin Ophthalmol [Internet]. 2017;11:1601–6. Available from: http://dx.doi.org/10.2147/OPTH.S140064
- De Luca, M. New techniques for the processing and analysis of retinal images in diagnostic ophthalmology. Padova Digital University archive [Internet]. 2008. [cited 2018 Dec 8]. Available from: http://paduaresearch.cab.unipd.it/443/1/DELUCAtesi.pdf
- Hussain N, Edraki M, Tahhan R, Sanalkumar N, Kenz S, Akasha NK, et al. Telemedicine for diabetic retinopathy screening using an ultra-widefield fundus camera. Clin Ophthalmol [Internet]. 2017;11:1477–82. Available from: http://dx.doi.org/10.2147/OPTH.S135287
- Kanagasingam Y, Xiao D, Vignarajan J, Preetham A, Tay-Kearney M-L, Mehrotra A. Evaluation of artificial intelligence–based grading of diabetic retinopathy in primary care. JAMA Netw Open [Internet]. 2018;1(5):e182665. Available from: http://dx.doi.org/10.1001/jamanetworkopen.2018.2665
Articles related to the one you are viewing
There are currently no results to show, please try again later
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.