title: Systematic screening of Retinopathy in Diabetes (REaD project): an Italian implementation campaign.
abstract: OBJECTIVE
  To evaluate the use of telemedicine retinal screening in Italy and to identify potential elements of implementation of this system.
  
  
  METHODS
  Patients with either new-onset diabetes or no ophthalmologic visit over the previous 2 years and attending 33 referral diabetic centers between mid-April 2013 and mid December 2015 were screened. Two partially overlapping nonstereoscopic 45° digital color images were captured from each eye using a fully automated nonmydriatic digital fundus camera. Factors limiting the assessment of retinopathy were explored.
  
  
  RESULTS
  Out of 24,473 eligible individuals, 22,466 had complete data. Among them, good-quality images enabling appropriate evaluation of at least one eye were obtained from 19,712 patients (both eyes, n = 18,887). Although nonmydriatic retinographs were provided, 39% of patients were evaluated using mydriasis. The rate of low-quality images in each center was inversely associated with the number of patients assessed. This was more evident for screening in mydriasis: adjusted odds ratio (OR) 0.79 (95% confidence interval (CI) 0.76-0.82) (p<0.001) vs 0.96 (95% CI 0.94-0.97) (p<0.001). Finally, both the number of patients assessed and use of mydriasis were inversely related to the presence of diabetic retinopathy (DR): adjusted OR 0.93 (95% CI 0.92-0.93) (p<0.001) and 0.88 (95% CI 0.82-0.96) (p<0.001), respectively.
  
  
  CONCLUSIONS
  This program confirmed a role for teleophthalmology in the systematic screening of DR and provided important suggestions to improve the system deployed. A high level of training is required for operators to optimize imaging. The role of mydriasis should be evaluated further.
authors.affiliation: Department of Medical Sciences, University of Turin, Turin - Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Porta
authors.affiliation: Eye Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Boscia
authors.affiliation: Department of Medical and Biological Sciences, Ophthalmology, University of Udine, Udine - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lanzetta
authors.affiliation: Diabetes Unit, Careggi Hospital, Florence - Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.affiliation: Careggi University Hospital, University of Florence, Florence - Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Menchini
authors.affiliation: Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples - Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Simonelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005451:Fluorescein Angiography; D006284:Health Plan Implementation; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017216:Telemedicine / Q000458:organization & administration*