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  • AAO OTAC Retina/Vitreous Panel, Hoskins Center for Quality Eye Care


    A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Retina/Vitreous Panel.

    Christina Y. Weng, MD, MBA1; Maureen G. Maguire, PhD2; Christina J. Flaxel, MD3; Nieraj Jain, MD4; Stephen J. Kim, MD5; Shriji Patel, MD, MBA5; Justine R. Smith, FRANZCO, PhD6; Leo A. Kim, MD, PhD7*; Steven Yeh, MD4,8*

    Ophthalmology, Vol 131, Issue 8, P927-942 © 2024 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: This American Academy of Ophthalmology Ophthalmic Technology Assessment aims to assess the effectiveness of conventional teleretinal screening (TS) in detecting diabetic retinopathy (DR) and diabetic macular edema (DME). 

    Methods: A literature search of the PubMed database was conducted most recently in July 2023 to identify data published between 2006 and 2023 on any of the following elements related to TS effectiveness: 1) the accuracy of TS in detecting DR or DME compared with traditional ophthalmic screening with dilated fundus examination or 7-standard field ETDRS photography, 2) the impact of TS on DR screening compliance rates or other patient behaviors, and 3) cost-effectiveness and patient satisfaction of TS compared with traditional DR screening. Identified studies were then rated based on the Oxford Centre for Evidence-Based Medicine grading system.

    Results: Eight level I studies, 14 level II studies, and 2 level III studies were identified in total. While cross-study comparison is challenging due to differences in reference standards and grading methods, TS demonstrated acceptable sensitivity and good specificity in detecting DR; moderate to good agreement between TS and reference-standard DR grading was observed. Performance of TS was not as robust in detecting DME, although the number of studies evaluating DME specifically was limited. Two level I studies, 5 level II studies, and 1 level III study supported that TS had a positive impact on overall DR screening compliance, even increasing it by more than two-fold in one study. Studies assessing cost-effectiveness and patient satisfaction were not formally graded, but they generally showed that TS was cost-effective and preferred by patients over traditional surveillance.

    Conclusions: Conventional TS is an effective approach to DR screening not only for its accuracy in detecting referrable-level disease but also for improving screening compliance in a cost-effective manner that may be preferred by patients. Further research is needed to elucidate the ideal approach of TS that may involve integration of artificial intelligence (AI) or other imaging technologies in the future.

    1Department of Ophthalmology, Baylor College of Medicine, Cullen Eye Institute, Houston, Texas
    2Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    3Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
    4Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
    5Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
    6College of Medicine and Public Health, Flinders University, Adelaide, South Australia
    7Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
    8Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska
    *Dr. Leo A. Kim and Dr. Steven Yeh are co-senior authors.