title: Improving diabetic retinopathy screening in Africa: patient satisfaction with teleophthalmology versus ophthalmologist-based screening.
abstract: OBJECTIVE
  To assess patient preference for diabetic retinopathy (DR) screening with teleophthalmology or face-to-face ophthalmologist evaluation in Nairobi, Kenya.
  
  
  METHODS
  Fifty seven diabetic patients from a one-stop multidisciplinary diabetic clinic (consisting of a diabetologist, nurse educator, foot specialist, nutritionist, ophthalmologist, and neurologist) in Nairobi, Kenya were included if they had undergone both a teleophthalmology (stereoscopic digital retinal photographs graded by an ophthalmologist remotely) and a traditional clinical screening exam (face to face examination). A structured questionnaire with a 5-point Likert scale was developed in both English and Swahili. The questionnaire was administered over the telephone. Ten questions were used to compare patient experience and preferences between teleophthalmology and a traditional clinical examination for DR. A mean score >3.25 on the Likert scale was considered favourable.
  
  
  RESULTS
  Successfully telephone contact was possible for 26 (58% male, 42% females) of the 57 patients. The mean ages of the male and female patients were 52.4 and 46.5 years respectively. Patients were satisfied with their teleophthalmology examination (mean 4.15 ± 0.97). Patients preferred the teleophthalmology option for future screenings (mean 3.42 ± 1.52). This preference was driven primarily by convenience, reduced examination time, and being able to visualize their own retina.
  
  
  CONCLUSIONS
  In this study, diabetic patients preferred a teleophthalmology based screening over a traditional ophthalmologist-based screening. The use of teleophthalmology in Africa warrants further study and has the potential to become the screening model of choice. Cost effectiveness in comparison to an ophthalmologist-based screening also requires evaluation.
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Khaliq
authors.initials: K
authors.lastname: Kurji
authors.forename: Dan
authors.initials: D
authors.lastname: Kiage
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rudnisky
authors.forename: Karim F
authors.initials: KF
authors.lastname: Damji
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009885:Ophthalmology / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010361:Patients / Q000523:psychology*; D011795:Surveys and Questionnaires; D019113:Telepathology / Q000379:methods*
keywords: Africa; Diabetes; Retinopathy; Teleophtalmology