Role of telemedicine in the screening of diabetic retinopathy: results of a pilot study

Introduction: the most recent scientific evidence showed that diabetic blindness can be drastically reduced through screening programs and early treatment of diabetic retinopathy (DR). Unfortunately, ARNO study data tell that in 2010 only 10% of a large Italian population of diabetic (DM) outpatients had fundus oculi (FO) examination during the previous year. Aim of the present study was thus to evaluate if telemedicine could actually optimize screening, diagnosis and management for retinopathy in the diabetic patient. Methods: the NO BLIND is a prospective multicentre observational transversal study. Here the preliminary findings of one of the 10 outpatient clinics involved (392 consecutive patients admitted to Marano (ASL NA2 Nord) outpatient clinic). FO photos taken by trained diabetologists with a portable digital retinograph and clinical/laboratory data were electronically collected. The enrolment period was of 6-12 months. The sample was split into two arms: controls (only FO) and new treatment (FO + retinography). Results: The 27.5% of controls had a DR diagnosis (vs 26.1% in the double screening; O.R. 0.931; 95% C.I.: 0.595-1.456; p=0.754), hence non-inferiority of retinography was not demonstrated. The overall analysis of significant general variables showed as only potential DR predictor a long duration of diabetes (O.R. 1.059; 95% C.I.: 1.029-1.091; p=0.000). Among pharmacologic variables instead, emerged as potential predictors: insulin (O.R. 2.914; 95% C.I.: 1.683-5.046; p=0.000) and sulfonylureas/glinides (O.R. 2.077; 95% C.I.: 1.24-3.479; p=0.006) therapy. Discussion: based on our data, retinography has demonstrated a screening method equivalent to FO in terms of sensibility and specificity, thus extremely useful to select the population at higher risk of ocular disease with an optimal cost/benefit ratio. Interesting was the correlation between DR and both somatic and autonomic neuropathy. It is certainly necessary to evaluate the whole cohort results. In fact, it is highly probable that final findings will demonstrate that this screening brings to a DR diagnosis in a high percentage of subjects without previous definite diagnosis. Finally, No-BLIND study will allow assessing real life correlation between DR, other DM complications and pharmacological treatments.