title: Diabetic retinopathy screening: the first telemedical approach in an Italian hospital.
abstract: OBJECTIVE
  To assess the feasibility of a telemedical approach for diabetic retinopathy (DR) screening in the Italian population and to evaluate advantages/disadvantages in comparison to standard slit-lamp funduscopic examination (SFE).
  
  
  METHODS
  This 1-year, Italian, single-center, observational study evaluated semiautomatic fundus photography (FP) DR screening, performed during routine type 2 diabetes (T2D) systemic visits and examined remotely. Adults with T2D underwent SFE and 3-field FP. The study was divided into 2 stages (stage 1 validated the screening procedure, stage 2 evaluated the screening impact on the clinical practice). Annual costs of SFE ± FP screening were compared. Patients completed a DR screening questionnaire.
  
  
  RESULTS
  Of 1,281 T2D patients enrolled, 61% were male (mean age 65.69 ± 12.64 years). In stage 1, 71% and 15% of patients were considered nongradable when FP was performed before (BPD) versus after pupil dilation (APD). The FP specificity was higher with APD vs BPD (79% vs 25%); therefore, FP APD only was used for stage 2. Of 1,281 patients screened using FP APD, 240 (18.7%) had unreadable images; 64.3% did not have DR, and 17.0% were diagnosed with DR. There was a cost saving of €801.25 when screening was performed using FP. Overall, 98% of patients had a positive opinion of FP screening.
  
  
  CONCLUSIONS
  The telemedicine approach provides a convenient, simple test that is well-received by patients and minimizes unnecessary referrals. Telemedicine may also reduce screening costs in our setting.
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Invernizzi
authors.affiliation: Endocrinology-Diabetology, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Maurizio T
authors.initials: MT
authors.lastname: Bevilacqua
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Cozzi
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bianchi
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pagani
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cigada
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Staurenghi
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000191:economics / Q000379:methods; D010781:Photography / Q000191:economics / Q000379:methods; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000379:methods*