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    The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has shown significant potential for intervention in the earliest phases of diabetic retinopathy (DR) when treatment can prevent vision loss. 

    The DR screening program was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. 

    Among 1,894 participants screened, 1 in 5 had early stage DR. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR, most commonly with cataract (30.7%), but also hypertensive retinopathy, glaucoma and AMD, suggesting an important collateral benefit of DR screening programs.

    This study provides early validation of the effectiveness of telemedicine in reaching underserved populations.

    Ocular imaging was performed by trained technicians using a nonmydriatic camera with autofocus (model AFC-230, Nidek Inc). Dark fabric was draped over the participant’s head and/or the room was darkened. Technicians were trained in camera use by the telemedicine reading center staff and followed the manufacturer’s standard operating instructions.

    Three photos were taken of each eye: anterior segment, nasal fundus, and temporal fundus. If the images were blurry, additional images were taken to achieve satisfactory quality. Images were generated using NAVIS-Lite software (Nidek Inc) and uploaded to a Health Insurance Portability and Accountability Act (HIPAA)–compliant secure website. Trained and certified readers read the images.

    However, because patients did not undergo a “gold standard” dilated eye exam, it also highlights a drawback of this study. It is possible that other ocular pathology was missed resulting in a falsely low rate of pathology. The authors also did not discuss the follow-up rate, but they plan to address this issue in subsequent reports.

    The authors conclude that the cost-effectiveness of the program expands the reach of screenings by accessing regions that may be experiencing a shortage of ophthalmologists and optometrists.

    Investigators suggest the study should be deployed on a larger scale, focusing on clinical settings in underserved areas across the nation.