title: Five-year experience of tele-ophthalmology for diabetic retinopathy screening in a rural population.
abstract: OBJECTIVE
  To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyse diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings.
  
  
  METHODS
  An observational randomised study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure >22mmHg. Statistical analysis was performed using the SPSS program (Student t and χ(2) tests).
  
  
  RESULTS
  DR prevalence was 12.1%. Patients with glycosylated haemoglobin values >7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR (P<.05). 43.3% of patients correctly referred to ophthalmologists showed moderate to severe DR. Unnecessary referrals to specialists were improved from 91.7% in 2010 to 98.6% in 2014. It is estimated that the program has made a total saving of €152,550.45.
  
  
  CONCLUSIONS
  Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs.
authors.affiliation: Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España. Electronic address: susanarodriguezvilla@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Rodríguez Villa
authors.affiliation: Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: C
authors.initials: C
authors.lastname: Alonso Álvarez
authors.affiliation: Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: R
authors.initials: R
authors.lastname: de Dios Del Valle
authors.affiliation: Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: R
authors.initials: R
authors.lastname: Salazar Méndez
authors.affiliation: Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: M
authors.initials: M
authors.lastname: Cuesta García
authors.affiliation: Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ruiz García
authors.affiliation: Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: M
authors.initials: M
authors.lastname: Cubillas Martín
authors.affiliation: Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez Vazquez
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D009885:Ophthalmology / Q000191:economics / Q000379:methods*; D058007:Physicians, Primary Care; D015995:Prevalence; D015397:Program Evaluation; D012017:Referral and Consultation / Q000191:economics; D012307:Risk Factors; D012424:Rural Population; D012494:Sampling Studies; D013030:Spain / Q000453:epidemiology; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D055815:Young Adult
keywords: Cribado de diabetes; Cámara no midriática; Diabetic retinopathy; Diabetic screening; Non-mydriatic fundus camera; Retinopatía diabética; Rural; Tele-ophthalmology; Telemedicina; Telemedicine; Teleoftalmología