Telemedicine screening program for diabetic retinopathy in patients with type 1 diabetes mellitus

Diabetic retinopathy (DR) is a heterogeneous disease arising from microangiopathic changes in the retina. Alterations in the small retinal vessels cause it. Increased vascular permeability leads to lipid exudation, hemorrhages, and proliferation of neovessels. DR develops over time in individuals with diabetes mellitus (DM), progressing from milder stages, such as non-proliferative DR, to vision-threatening stages, such as proliferative DR and diabetic macular edema.1, 2, 3

DR is the most common and specific microvascular complication of DM, reaching a prevalence of 30% in patients with DM. It has a major impact on health and social care as the leading preventable cause of blindness in the working-age population. This prevalence is not constant and increases with the duration of DM and the patient's age.1 Hyperglycemia, high blood pressure, microalbuminuria, and pregnancy are also risk factors for the development of DR.

DR is a condition that meets the basic criteria for a screening program: large volume of potentially affected individuals, the potential severity of the clinical presentation, the natural course can be predicted and reversed if associated risk factors are controlled, and effective treatment is available.3, 4

A high burden of care is involved in screening programs such as those for DR. Even with sufficient numbers of ophthalmologists, reliance on them for DR screening has proven to be an inefficient use of resources. This, together with improved communication technologies, has led to the implementation of telemedicine systems. These telemedicine systems are already being developed in Spain with good results.5 These programs involve obtaining images (retinal fundus photographs) which are then assessed by trained personnel who are not necessarily ophthalmologists.4, 6 In addition, new artificial intelligence systems have appeared, allowing adequate screening, with similar results to manual grading.7

Given the prevalence and morbidity associated with DR, this study's aim was to analyze the results of our DR telemedicine screening program in patients with type 1 DM being followed in specialized consultation in the Endocrinology and Nutrition Management Unit (ENMU) of Virgen del Rocío University Hospital.

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