Clinical research
Detection of glaucoma-like optic discs in a diabetes teleretinal program

https://doi.org/10.1016/j.optm.2007.04.101Get rights and content

Abstract

Background

Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM) in several studies. We assessed the sensitivity and specificity of a diabetes teleretinal program to identify the glaucoma-suspicious optic disc.

Methods

Outpatients with DM (N = 1,644) presenting to Veterans Affairs ambulatory clinics participated in a nonmydriatic digital retinal imaging (NMDRI) program. Technicians transmitted digital retinal images electronically to readers for grading and eye care recommendations. Patients were referred for ophthalmic care based on the level of diabetic retinopathy and other ocular findings, including optic nerve changes suspicious for glaucoma. We retrospectively reviewed the electronic medical records of patients labeled as glaucoma suspects (N = 175) and compared them with those of patients from the same imaging pool who were not regarded as glaucoma suspects (N = 175). Ophthalmic data obtained from a comprehensive eye examination after digital retinal imaging was used to determine which patients met predefined criteria for the optic disc suggestive of glaucoma.

Results

Assessment of clinical data obtained after NMDRI found that 103 of 175 (59%) glaucoma suspects had glaucoma-suspicious optic discs. In the comparison group, only 7 of 175 (4%) had glaucoma-suspicious optic discs.

Conclusions

Although specificity was high (96%), modifications in diabetes teleretinal imaging programs are needed to improve the sensitivity of detecting the optic disc that is suspicious for glaucoma.

Section snippets

Methods

This is a retrospective observational study of 1,644 patients with DM who were accessed consecutively from May 2002 to March 2004 as part of a Diabetes Teleretinal Program. The Institutional Review Board and Research and Development Committee at VA Boston Healthcare System approved this study.

Patients with DM who did not have a record of a comprehensive eye examination within the previous 11 months were accessed for digital retinal imaging when they presented to 2 ambulatory care clinics.

Results

Review of the teleretinal imaging reports on patients in group 1 indicated readers made their determination of glaucoma suspect for the following reasons: suspicious cupping, CDR asymmetry, neuroretinal rim excavation, or thinning. In no instance did the readers comment that they found a disc hemorrhage or that the nerve fiber layer was defective. For patients identified as glaucoma suspects (group 1), readers were able to evaluate 157 of 175 (90%) for level of DR. For patients not regarded as

Discussion

Previous reports indicate that NMDRI is effective for diagnosing level of DR.20, 22, 24 Additionally, although not validated in rigorous prospective trials, NMDRI has the potential to detect other important ocular and systemic-related conditions. Our findings suggest that NMDRI is a useful tool for identifying optic nerve head findings suspicious for glaucoma in a primary care setting, although formalized grading strategies are needed to maximize the ability to detect glaucoma-suspicious optic

Acknowledgments

This work was presented in part at the 2005 American Telemedicine Association meeting, April 18, 2005, in Denver, Colorado. The authors have no financial interest related to this article.

This work was supported by the Department of Defense grant (Conlin).

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    Members of the Ocular TeleHealth Team who made significant contributions to this work: Anthony A. Cavallerano, O.D., Ocular TeleHealth Center, VA Boston Healthcare System–Jamaica Plain Campus, Jamaica Plain, Massachusetts; New England College of Optometry, Boston, Massachusetts. Gerald Selvin, O.D., Ocular TeleHealth Center, VA Boston Healthcare System–Jamaica Plain Campus, Jamaica Plain, Massachusetts; New England College of Optometry, Boston, Massachusetts. Kristin Colonna, B.S., New England College of Optometry, Boston, Massachusetts. Ghassan Ghorayeb, M.D., Boston University School of Medicine, Department of Ophthalmology, Boston, Massachusetts. Funding for the Diabetes Teleretinal program was provided in part from a contract sponsored by the Department of the Army by means of Cooperative Agreement DAMD 17-98-2-8017 for the Joslin/Department of Defense (DoD)/Veterans Administration (VA) Program. The views expressed in this article are those of the authors and do not necessarily reflect the position and policy of the United States Federal Government, the Department of Veterans Affairs or the Department of Defense. No official endorsement should be inferred.

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