title: Telemedicine and Diabetic Retinopathy: Review of Published Screening Programs.
abstract: BACKGROUND
  Diabetic Retinopathy (DR) is a leading cause of blindness worldwide even though successful treatments exist. Improving screening and treatment could avoid many cases of vision loss. However, due to an increasing prevalence of diabetes, traditional in-person screening for DR for every diabetic patient is not feasible. Telemedicine is one viable solution to provide high-quality and efficient screening to large number of diabetic patients.
  
  
  OBJECTIVE
  To provide a narrative review of large DR telemedicine screening programs.
  
  
  METHODS
  Articles were identified through a comprehensive search of the English-language literature published between 2000 and 2014. Telemedicine screening programs were included for review if they had published data on at least 150 patients and had available validation studies supporting their model. Screening programs were then categorized according to their American Telemedicine Association Validation Level.
  
  
  RESULTS
  Seven programs from the US and abroad were identified and included in the review. Three programs were Category 1 programs (Ophdiat, EyePacs, and Digiscope), two were Category 2 programs (Eye Check, NHS Diabetic Eye Screening Program), and two were Category 3 programs (Joslin Vision Network, Alberta Screening Program). No program was identified that claimed category 4 status. Programs ranged from community or city level programs to large nationwide programs including millions of individuals. The programs demonstrated a high level of clinical accuracy in screening for DR. There was no consensus amongst the programs regarding the need for dilation, need for stereoscopic images, or the level of training for approved image graders.
  
  
  CONCLUSIONS
  Telemedicine programs have been clinically validated and successfully implemented across the globe. They can provide a high-level of clinical accuracy for screening for DR while improving patient access in a cost-effective and scalable manner.
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Tozer
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Woodward
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Newman-Casey
keywords: Diabetic retinopathy; Screening programs; Telemedicine