title: A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center--the Joslin Vision Network Eye Health Care Model.
abstract: OBJECTIVE
  To extend access to diabetic eye care and characterize the extent of diabetic retinopathy {DR) and other ocular findings using the Joslin Vision Network (JVN).
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Outpatients at the Togus VA Medical Center with diabetes mellitus, impaired fasting glucose, or impaired glucose tolerance underwent JVN protocol imaging. Images were transmitted to the Joslin Diabetes Center for grading and recommended treatment plan.
  
  
  RESULTS
  The study included 1,219 patients (2,437 eyes); 1,536 eyes (63.0%) had no (DR), 389 (16.0%) had mild nonproliferative DR (NPDR), 105 (4.3%) moderate NPDR, 35 (1.4%) severe NPDR, 20 (0.8%) very severe NPDR, and 21 (0.9%) had proliferative DR (PDR). Regarding diabetic macular edema (DME), 1,907 eyes (78.3%) had no DME, 34 (1.4%) had early DME, and 16 (0.7%) had clinically significant macular edema (CSME). Of all patients, 354 (29.0%) had either no DR or mild NPDR in both eyes, no evidence of DME, and no significant nondiabetic findings; 679 (55.7%) had no DR in either eye, and 229 (18.8%) had mild NPDR in the more severe eye. Of the 908 patients (74.5%) with either no DR or mild NPDR in the more severe eye, 533 (58.7%) had at least one nondiabetic ocular finding necessitating referral. Finally, 320 eyes (13.1%) were ungradable for both DR and DME and 160 (6.6%) were ungradable for DME alone.
  
  
  CONCLUSIONS
  In a non-ophthalmic setting, JVN identifies the severity of DR and nondiabetic ocular conditions, permitting appropriate triage for eye care.
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: Beatrice
authors.initials: B
authors.lastname: Blake
authors.forename: Michael
authors.initials: M
authors.lastname: Rynne
authors.forename: Paul R
authors.initials: PR
authors.lastname: Conlin
authors.forename: Kristen
authors.initials: K
authors.lastname: Hock
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology*; D012189:Retrospective Studies; D019113:Telepathology / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs