title: Use of Joslin Vision Network digital-video nonmydriatic retinal imaging to assess diabetic retinopathy in a clinical program.
abstract: OBJECTIVE
  To incorporate a nonmydriatic, digital-video retinal imaging system into a Diabetes Outpatient Intensive Treatment Program and to evaluate the system's ability to assess diabetic retinopathy (DR), determine follow-up, and appropriately refer to retinal specialist ophthalmologists.
  
  
  METHODS
  Fundus images were obtained according to Joslin Vision Network (JVN) protocol and evaluated by certified JVN readers. Patients with significant retinal disease underwent evaluation by retinal specialists.
  
  
  RESULTS
  A total of 268 (51.0%) of 525 imaged patients had comprehensive eye examination by a retinal specialist owing to referable JVN-assessed clinical level of DR, nondiabetic ocular disease, ungradeable images, last eye examination >/=12 months prior, or patient request for examination. JVN diagnosis of a clinical level of DR agreed exactly with clinical findings in 388 eyes (72.5%) or within one level in 478 eyes (89.3%). JVN referral based on most severe diagnosis in either eye matched retinal specialist-recommended follow-up in 248/268 of patients (92.5%). A total of 136/525 (25.9%) of JVN patients had nondiabetic ocular abnormalities requiring referral.
  
  
  CONCLUSIONS
  Recommended follow-up from JVN imaging compared favorably to clinical examination by a retinal specialist. Nondiabetic ocular pathology was identified. JVN assessment of DR level compares favorably to clinical practice, potentially improving access to eye care and enhancing diabetes management.
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, MA 02215, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Cavallerano
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Cavallerano
authors.forename: Paula
authors.initials: P
authors.lastname: Katalinic
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Tolson
authors.forename: Lloyd Paul
authors.initials: LP
authors.lastname: Aiello
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Aiello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000145:classification / Q000473:pathology*; D003937:Diagnosis, Differential; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007255:Information Services; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010045:Outpatients; D017064:Process Assessment, Health Care; D012017:Referral and Consultation; D012160:Retina / Q000473:pathology*; D013038:Specialization; D019113:Telepathology / Q000592:standards; D013997:Time Factors