title: Marked reductions in visual impairment due to diabetic retinopathy achieved by efficient screening and timely treatment.
abstract: OBJECTIVE
  Diabetic retinopathy (DR) is the most common complication of diabetes and needs to be diagnosed early to prevent severe sight-threatening retinopathy. Digital photography with telemedicine connections is a novel way to deliver cost-effective, accessible screening to remote areas. Screening for DR in a mobile eye examination unit (EyeMo) is compared to traditional service models (i.e. local municipal services or a commercial service provider). The quality of images, delays from screening to treatment, the stage of DR, coverage of screening and the rate of visual impairment due to DR are evaluated.
  
  
  METHODS
  EyeMo utilizes telemedicine technology. The electronic databases of the hospital and information from the Finnish Register of Visual Impairment were used to determine delays and the rate of visual impairment.
  
  
  RESULTS
  Fourteen thousand eight hundred and sixty-six fundus photographs were taken in EyeMo in 2007-2011. Coverage reached 78% of potential clients. No DR was detected in 43%, mild background retinopathy in 23%, moderate or severe background retinopathy in 31% and proliferative retinopathy in 3% of the evaluations. The quality of images was higher (p < 0.01) and delays shorter (p < 0.01) in EyeMo as compared to traditional service models. The rate of visual impairment due to DR decreased by 86% in the area covered by EyeMo, and the change compared favourably to the situation in the entire Finland (p < 0.0005).
  
  
  CONCLUSIONS
  EyeMo is a feasible model of telemedicine application for screening of DR. Effective screening and timely access to care may indeed have influenced the reduced rate of visual damage.
authors.affiliation: Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Hautala
authors.forename: Riittaliisa
authors.initials: R
authors.lastname: Aikkila
authors.forename: Juha
authors.initials: J
authors.lastname: Korpelainen
authors.forename: Antti
authors.initials: A
authors.lastname: Keskitalo
authors.forename: Anne
authors.initials: A
authors.lastname: Kurikka
authors.forename: Aura
authors.initials: A
authors.lastname: Falck
authors.forename: Risto
authors.initials: R
authors.lastname: Bloigu
authors.forename: Hannu
authors.initials: H
authors.lastname: Alanko
mesh_terms: D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D008952:Mobile Health Units; D010781:Photography / Q000379:methods; D012042:Registries; D017216:Telemedicine / Q000379:methods*; D014786:Vision Disorders / Q000517:prevention & control*; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*
keywords: diabetes; diabetic retinopathy; screening; telemedicine; visual impairment