Modeling a Community tele-Screening for Diabetic Retinopathy in a Remote Area in Iran
Sare Safi, PhD1 , Fatemeh Sahraee, MD2 , Mohammad Reza Dehghani, MD, PhD2 , Elham Ashrafi, PhD3 , Mehdi Pourrezaei2, MD,Abouzar Ataee2,Mohammad Reza Sadeghian2, MD,Masoud Reza Manaviat2, MD,Mohammad Ali Evazinejad2, MD,Ali Zare, BS 2 , Mansour Ranjbar, MD4 , Alireza Mahdavi, MD5 , Seyed Farzad Mohammadi, MD, MPH - Corresponding author3 , Alireza Ramezani, MD1 , Hamid Ahmadieh, MD - Corresponding author6 *
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Sadoughi University of Medical Science, Yazd, Iran
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- World Health Organization Office in Iran
- Center for Non-Communicable Diseases Control, Iran Ministry of Health and Medical Education
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: To model a community-oriented diabetic retinopathy (DR) tele-screening program for remote areas and to implement a pilot study in Yazd Province.
Methods: The study was conducted as a Joint Program Review Mission (JPRM) between the World Health Organization and Iran Ministry of Health and Medical Education (MOHME) in collaboration with the Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences and Shahid Sadoughi University of Medical Sciences. Firstly, the minimum data set was prepared and presented to the Center for Health Networks Management at the MOHME to facilitate the data exchange between Integrated Health Information System “SIB” and DR tele-screening custom software “IRTOS”*. Secondly, we established a reading center at a Health Center in Yazd City. A two-day per week clinic was assigned to the referred screening positive cases at a tertiary hospital in Yazd City. Thirdly, a distance training course was developed to train the general practitioner (GPs) who were in charge of reading the fundus digital images. A one-day workshop was set up for Behvarses (Community Health Workers: CHWs) to perform digital image capture at the Khatam District. Fourthly, the registered people with diabetes in Khatam District were invited for screening. CHWs measured the pinhole best-corrected VA and captured three fundus images from each eye. Then, the images were transferred to the reading center via IRTOS to be graded by the trained GPs. CHWs were informed about the screening results via IRTOS.
*IRTOS was upgraded based on the MOHME recommended standards for exchanging data in collaboration with Sadra System Tadbir Company.
Results: Two hundred and five individuals with diabetes with the mean age of 59.14?±11.71?years were screened. The mean duration of diabetes was 68.69±60.18 months. Seventy three percent of subjects had no history of ocular examination. Totally, 38.5% were categorized as referable to a retinal specialist in Yazd City for further evaluation. Of these, 70% complied with the advice to be visited by an ophthalmologist.
Conclusion: This pilot study proved the practicality of taking fundal images at community level and showed that the tele-screening approach can successfully screen out persons with no DR, mild to moderate non-proliferative DR with grossly normal macula and good VA from further standard ophthalmologist in-person visits.
