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Teleophthalmology Support for Primary Care Diagnosis and Management

Elmar Torres, Paulo H. Morales, Olimpio J.N.V. Bittar, Nacime S. Mansur, Solange R. Salomão, Rubens Belfort Jr


This study was performed to evaluate a healthcare strategy based on teleophthalmology for diagnosis and management of primary healthcare users. A descriptive cross-sectional study was conducted to review the medical records of patients from January 2013 to December 2014 from primary care units in the city of São Paulo. The units referred patients, who had diabetes or high blood pressure, and were users of chloroquine compounds, for a fundus examination. The images were sent to a reading center for review, diagnosis, and patient referrals. From 9173 analyzed patients, 570 (6.2%) were excluded because of poor image quality. Of the remaining patients, 4933 (57.3%) had diabetes, 7242 (84,2%) systemic hypertension, and 113 (1.3%) used chloroquine. Of these, 989 (11.5%) patients needed ophthalmologic treatment. The most frequently prescribed treatments were cataract extraction in 692 (70%) of 989 and photocoagulation in 245 (24.8%) of 989 cases. Overall, cataract extraction was indicated in 692 (8%) of 8603 cases and photocoagulation in 245 (2.8%) of 8603 cases. When only patients with diabetes were considered, the indication for photocoagulation increased to 4.5%.The results showed that non-medical professionals could produce good-quality ocular images for screening of ocular diseases in most cases; only 6.2% of ocular images did not meet quality requirements. Most patients referred for fundus examination did not need a specific treatment, indicating that this system could be an inexpensive and reliable tool for use in developing countries.



Blomdahl S, Calissendorff B, Jacobsson U. Patient-focused urban tele-ophthalmology services. J Telemed Telecare. 2002;8 Suppl 2:43-4. pmid: 10.1177/1357633X020080S219 pmid: 12217130

Nathan DM. Diabetes: Advances in Diagnosis and Treatment. JAMA. 2015;314(10):1052-62. pmid: 10.1001/jama.2015.9536 pmid: 26348754

Pereira JM, Salomao SR, Cinoto RW, Mendieta L, Sacai PY, Berezovsky A, et al. [Eye care services evaluation in a low-income urban population of Sao Paulo City--Brazil]. Arq Bras Oftalmol. 2009;72(3):332-40. pmid: 19668962

Belfort R, Jr. 80 years of Arquivos Brasileiros de Oftalmologia (ABO). Arq Bras Oftalmol. 2018;81(1):0. pmid: 10.5935/0004-2749.20180002 pmid: 29538603

Andonegui J, Serrano L, Eguzkiza A, Berastegui L, Jimenez-Lasanta L, Aliseda D, et al. Diabetic retinopathy screening using tele-ophthalmology in a primary care setting. J Telemed Telecare. 2010;16(8):429-32. pmid: 10.1258/jtt.2010.091204 pmid: 20813892

Malerbi FK, Morales PH, Farah ME, Drummond KR, Mattos TC, Pinheiro AA, et al. Comparison between binocular indirect ophthalmoscopy and digital retinography for diabetic retinopathy screening: the multicenter Brazilian Type 1 Diabetes Study. Diabetol Metab Syndr. 2015;7:116. pmid: 10.1186/s13098-015-0110-8 pmid: 26697120

Philip S, Fleming AD, Goatman KA, Fonseca S, McNamee P, Scotland GS, et al. The efficacy of automated "disease/no disease" grading for diabetic retinopathy in a systematic screening programme. Br J Ophthalmol. 2007;91(11):1512-7. pmid: 10.1136/bjo. 2007.119453 pmid: 17504851

Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF, American Academy of O. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002;109(7):1377-82. pmid: 12093666

Schmidt MI, Duncan BB, Hoffmann JF, Moura L, Malta DC, Carvalho RM. Prevalence of diabetes and hypertension based on self-reported morbidity survey, Brazil, 2006. Rev Saude Publica. 2009;43 Suppl 2:74-82. pmid: 19936501

Tan JC, Poh EW, Srinivasan S, Lim TH. A pilot trial of tele-ophthalmology for diagnosis of chronic blurred vision. J Telemed Telecare. 2013;19(2):65-9. pmid: 10.1177/1357633X13476233 pmid: 23520212

Blomdahl S, Maren N, Lof R. Tele-ophthalmology for the treatment in primary care of disorders in the anterior part of the eye. J Telemed Telecare. 2001;7 Suppl 1:25-6. pmid: 10.1177/1357633X010070S110 pmid: 11576480

de Mul M, de Bont AA, Reus NJ, Lemij HG, Berg M. Improving the quality of eye care with tele-ophthalmology: shared-care glaucoma screening. J Telemed Telecare. 2004;10(6):331-6. pmid: 10.1258/1357633042602107 pmid: 15603630

Pareja-Rios A, Bonaque-Gonzalez S, Serrano-Garcia M, Cabrera-Lopez F, Abreu-Reyes P, Marrero-Saavedra MD. Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience. Arch Soc Esp Oftalmol. 2017;92(2):63-70. pmid: 10.1016/j.oftal.2016.08.006 pmid: 27756515

Gonzalez F, Iglesias R, Suarez A, Gomez-Ulla F, Perez R. Teleophthalmology link between a primary health care centre and a reference hospital. Med Inform Internet Med. 2001;26(4):251-63. pmid: 11783710

Arriozola-Rodriguez KJ, Serna-Ojeda JC, Martinez-Hernandez VA, Rodriguez-Loaiza JL. Hypertensive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case. Case Rep Ophthalmol. 2015;6(3):415-9. pmid: 10.1159/000442660 pmid: 26955342

Grunwald JE, Alexander J, Ying GS, Maguire M, Daniel E, Whittock-Martin R, et al. Retinopathy and chronic kidney disease in the Chronic Renal Insufficiency Cohort (CRIC) study. Arch Ophthalmol. 2012;130(9):1136-44. pmid: 10.1001/archophthalmol. 2012.1800 pmid: 22965589

Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010;376(9735):124-36. pmid: 10.1016/S01 40-6736(09)62124-3 pmid: 20580421

Araujo Filho A, Salomao SR, Berezovsky A, Cinoto RW, Morales PH, Santos FR, et al. Prevalence of visual impairment, blindness, ocular disorders and cataract surgery outcomes in low-income elderly from a metropolitan region of Sao Paulo--Brazil. Arq Bras Oftalmol. 2008;71(2):246-53. pmid: 18516427

Salomao SR, Cinoto RW, Berezovsky A, Araujo-Filho A, Mitsuhiro MR, Mendieta L, et al. Prevalence and causes of vision impairment and blindness in older adults in Brazil: the Sao Paulo Eye Study. Ophthalmic Epidemiol. 2008;15(3):167-75. pmid: 10.1080/09286 580701843812 pmid: 18569812

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64. pmid: 10.2337/dc11-1909 pmid: 22301125

Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298(8):902-16. pmid: 10.1001/jama.298.8.902 pmid: 17712074

Schellini SA, Carvalho GM, Rendeiro FS, Padovani CR, Hirai FE. Prevalence of diabetes and diabetic retinopathy in a Brazilian population. Ophthalmic Epidemiol. 2014;21(1):33-8. pmid: 10.3109/092865 86.2013.868004 pmid: 24467560

Carlos GA, Schellini SA, Espindola RF, Lana FP, Rodrigues AC, Padovani CR. Cataract prevalence in Central-West region of Sao Paulo State, Brazil. Arq Bras Oftalmol. 2009;72(3):375-9. pmid: 19668970

Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, et al. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technol Assess. 2015;19(51):v-xxviii, 1-247. pmid: 10.3310/hta19510 pmid: 26173799

Stitt AW, Curtis TM, Chen M, Medina RJ, McKay GJ, Jenkins A, et al. The progress in understanding and treatment of diabetic retinopathy. Prog Retin Eye Res. 2016;51:156-86. pmid: 10.1016/j.preteyeres.2015.08. 001 pmid: 26297071

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