Canadian study shows patient benefits of systematic telescreening for diabetic retinopathy

Montréal 17 January 2002There is new hope for persons living with diabetes. Remote and discomfort-free screening for diabetic retinopathy is now possible thanks to a special digital camera used in a telemedicine situation that takes advantage of Québec's Réseau de Télécommunications Socio-Sanitaire (RTSS). During a study conducted in April 2001 in the Varennes-area, CLSC des Seigneuries validated the application of standard techniques required for the progressive implementation of an economical mass screening of diabetics. It was carried out under real conditions with its diabetic population, therefore using an uncontrolled study method.


Overcoming expected organisational problems, the study demonstrated that digital camera-aided telescreening presents numerous advantages, in addition to reducing blindness. It should notably reduce time waiting for appointments with ophthalmologists and screening waits.

Among other advantages, taking pictures with this camera does not cause discomfort to the diabetic person because, unlike regular testing by an ophthalmologist, telescreening does not require the use of eye drops. Finally, medical resources can concentrate their expertise on the people screened who need medical follow-up. This is essentially what is revealed by the study initiated and led by Dr. Marie-Carole Boucher, ophthalmologist at the Hôpital Maisonneuve-Rosemont's diabetic retinopathy clinic.

The pilot project demonstrated that 18 percent of the diabetics who participated in the telescreening of the condition went undiagnosed in traditional screening. In comparison, as part of an external endocrinology clinic, 6.2 percent of diabetic persons were caught in the same way. In addition, researchers consider that with a mass screening programme, six out of ten persons followed by an ophthalmologist could avoid regular screening tests, enhancing the margin of time available to ophthalmologists for follow-up and eventual treatment of those screened at the right time.

Having proven its reliability, comfort and speed, telescreening with a non-mydriatic camera coupled with the RTSS network could be the key factor in a successful mass screening programme for persons living with diabetes. Tied to an awareness campaign, the World Health Organisation confirms that mass screening could reduce the risks of blindness among diabetics by a third over a five-year term.

"For the moment, caution dictates setting the disease's screening bar on the presence or non-presence of diabetic retinopathy", stated Dr. Boucher. "We know that diabetic retinopathy is a silent disease whose predictable evolution ravages the active diabetic population - two out of ten diabetics sixty years of age or less - while a known treatment exists to avoid eventual blindness. It is not acceptable to be unable to offer our patients this treatment, simply because they have not been tested. We have just reached a major milestone in remote screening of diabetic retinopathy and can now pursue our work and turn our study's results into public health results."

The report was submitted to the Ministère de la Santé et des Services Sociaux. Dr. Boucher and her team hope that the file will receive priority attention such that the organisational issues regarding the follow-up and treatment of a greater number of screened persons, as applicable, could be enhanced and the general conditions of the experience be validated on a larger scale, for example in a regional territory, before undertaking a mass screening programme.

Currently connecting the network's various establishments, the RTSS could be used in the long run to link CLSCs or all other preventive service centres. In Varennes, nominal and clinical screening data were transmitted separately as per the Hôpital Maisonneuve-Rosemont's strict protocol. A team of ophthalmologists blindly interpreted the CLSC's results and the outcome confirmed the RTSS' efficacy.

The study highlights the importance of organising a complete telemedical network, including medical, professional and community-based resources, which would take into account regional disparities and the size of the territory. Optimal utilisation of secondary medical resources, in particular ophthalmologists, is key to the follow-up of screened persons.

For Dr. Boucher, the principal stake in public health involves ensuring that the eyes of all persons living with diabetes are regularly tested, which means that all players involved in the process must be on board. Between 1990 and 1998, incidences of diabetes have increased by 30 percent in the United States and it is believed that in Canada the number of cases will double by 2025, attributed mainly to ageing, obesity, and the lack of exercise.

A Université de Montréal-affiliated health centre, the Hôpital Maisonneuve-Rosemont is also the Québec reference centre in numerous specialised fields, including ophthalmology. The Centre de Recherche Guy Bernier, which is tied to the hospital, is renowned on the world stage for the evaluation of corneal transplant techniques, laser treatment of myopia, as well as retinal and glaucoma treatments.

Leslie Versweyveld

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