Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice
Open Access

Teleretina screening for diabetic retinopathy

Daniel Rosenberg, Jason Noble and Varun Chaudhary
CMAJ July 05, 2021 193 (26) E1006; DOI: https://doi.org/10.1503/cmaj.202141
Daniel Rosenberg
Michael G. DeGroote School of Medicine (Rosenberg), McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences (Noble); Sunnybrook Health Sciences Centre (Noble), Toronto, Ont.; Department of Surgery, Division of Ophthalmology (Chaudhary); Department of Health Research Methods, Evidence and Impact (Chaudhary), McMaster University; St. Joseph’s Healthcare Hamilton (Chaudhary), Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jason Noble
Michael G. DeGroote School of Medicine (Rosenberg), McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences (Noble); Sunnybrook Health Sciences Centre (Noble), Toronto, Ont.; Department of Surgery, Division of Ophthalmology (Chaudhary); Department of Health Research Methods, Evidence and Impact (Chaudhary), McMaster University; St. Joseph’s Healthcare Hamilton (Chaudhary), Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Varun Chaudhary
Michael G. DeGroote School of Medicine (Rosenberg), McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences (Noble); Sunnybrook Health Sciences Centre (Noble), Toronto, Ont.; Department of Surgery, Division of Ophthalmology (Chaudhary); Department of Health Research Methods, Evidence and Impact (Chaudhary), McMaster University; St. Joseph’s Healthcare Hamilton (Chaudhary), Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Ophthalmic screening is essential for detection of diabetic retinopathy

Diabetes Canada recommends eye exams every 1–2 years upon diagnosis of type 2 diabetes.1 A systematic review found that an average of 175 (range 75–267) screening sessions are required to detect 1 case of sight-threatening diabetic retinopathy in patients without retinopathy at baseline.2

Teleretina screening is a viable adjunct to in-person screening

Teleretina screening involves digital transmission of ocular images obtained by a technician for remote evaluation by a specialist (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.202141/tab-related-content). Technicians typically require one-on-one training with a teleophthalmology expert to effectively capture images.3 High-level evidence shows > 95% sensitivity and specificity for detection of diabetic retinopathy using teleretina screening.1 Teleretina screening is associated with reduced costs relative to in-person assessment.3

Patients with diabetes are more likely to participate in remote screening than in-person visits

A recent meta-analysis found significantly greater patient attendance for teleretina screening compared with traditional in-person assessment (odds ratio 13.15, 95% confidence interval 8.01–21.61, p < 0.001).4 Patients in poor health with limited access to health care professionals have challenges attending in-person screening; these patients are a target demographic for teleretina assessment.1

Teleretina screening is not available or recommended for all patients

Current evidence-based guidelines for teleretina screening apply only to nonpregnant patients aged 12 years or older with type 2 diabetes.5 Occasionally, images obtained during telescreening may be deemed “ungradable,” requiring an in-person assessment.1 Conditions that may interfere with the digital photo acquisition include dense cataracts or corneal scars.6

Centralized teleretina referral systems are in development in Canada

Several teleretina clinics have been initiated across Canada.1 Primary care providers are encouraged to contact the Canadian Retina Society (www.crssrc.ca) for further information and guidance on referral to telescreening programs.

Footnotes

  • Competing interests: Jason Noble serves on the advisory board for Novartis and Bayer and is a speaker for Novartis. Varun Chaudhary has served on the advisory board and as a consultant for Novartis, Bayer and Roche, and has investigator-sponsored research grants and participates in clinical trials funded by Novartis, Bayer and Allergan. All of these competing interests are outside the submitted work. No other competing interests were declared.

  • This article has been peer reviewed.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    1. Hooper P,
    2. Boucher M,
    3. Cruess A,
    4. et al
    . Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol 2017;52(Suppl 1): S45–74.
    OpenUrl
  2. ↵
    1. Groeneveld Y,
    2. Tavenier D,
    3. Blom JW,
    4. et al
    . Incidence of sight-threatening diabetic retinopathy in people with type 2 diabetes mellitus and numbers needed to screen: a systematic review. Diabet Med 2019;36:1199–208.
    OpenUrl
  3. ↵
    1. Kim J,
    2. Driver DD
    . Teleophthalmology for first nations clients at risk of diabetic retinopathy: a mixed methods evaluation. JMIR Med Inform 2015;3:e10.
    OpenUrlPubMed
  4. ↵
    1. Kawaguchi A,
    2. Sharafeldin N,
    3. Sundaram A,
    4. et al
    . Tele-ophthalmology for age-related macular degeneration and diabetic retinopathy screening: a systematic review and meta-analysis. Telemed J E Health 2018;24:301–8.
    OpenUrl
  5. ↵
    1. Boucher MC,
    2. Qian J,
    3. Brent MH,
    4. et al
    .; Steering Committee for Tele-Ophthalmology Screening, Canadian Retina Research Network. Evidence-based Canadian guidelines for tele-retina screening for diabetic retinopathy: recommendations from the Canadian Retina Research Network (CR2N) Tele-Retina Steering Committee. Can J Ophthalmol 2020;55(Suppl 1):14–24.
    OpenUrl
  6. ↵
    1. Silva PS,
    2. Horton MB,
    3. Clary D,
    4. et al
    . Identification of diabetic retinopathy and ungradable image rate with ultrawide field imaging in a national teleophthalmology program. Ophthalmology 2016;123:1360–7.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 193 (26)
CMAJ
Vol. 193, Issue 26
5 Jul 2021
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Teleretina screening for diabetic retinopathy
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Teleretina screening for diabetic retinopathy
Daniel Rosenberg, Jason Noble, Varun Chaudhary
CMAJ Jul 2021, 193 (26) E1006; DOI: 10.1503/cmaj.202141

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Teleretina screening for diabetic retinopathy
Daniel Rosenberg, Jason Noble, Varun Chaudhary
CMAJ Jul 2021, 193 (26) E1006; DOI: 10.1503/cmaj.202141
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Ophthalmic screening is essential for detection of diabetic retinopathy
    • Teleretina screening is a viable adjunct to in-person screening
    • Patients with diabetes are more likely to participate in remote screening than in-person visits
    • Teleretina screening is not available or recommended for all patients
    • Centralized teleretina referral systems are in development in Canada
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Recours au télédépistage pour la rétinopathie diabétique
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Pneumopericardium as a complication of pericardiocentesis
  • A blistering variant of phlegmasia cerulea dolens from underlying squamous cell lung cancer
  • Parechovirus infections in infants
Show more Practice

Similar Articles

Collections

  • Article Types
    • Five Things to Know About
  • Topics
    • Diabetes
    • Family medicine, general practice, primary care
    • Health services
    • Ophthalmology
    • Screening & diagnostic tests

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire