Evaluating the impact of optical coherence tomography in diabetic retinopathy screening for an Aboriginal population.

IMPORTANCE: Optical coherence tomography is used routinely in management of diabetic eye disease but has not been evaluated in Australian outreach settings for screening programmes.

BACKGROUND: The study aims to evaluate the use of optical coherence tomography combined with a fundus camera compared with a fundus camera only in a telehealth diabetic retinopathy screening programme for Aboriginal Australians.

DESIGN: Retrospective comparative study was used.

PARTICIPANTS: The study included patients with diabetes at two Aboriginal Health Services.

METHODS: An intervention group was studied in 2015 using a Topcon 3D optical coherence tomography-1 Maestro combined with optical coherence tomography/fundus camera. A control group was studied in 2014 using a DRS non-mydriatic fundus camera. Fundus photographs were emailed to trained retinal graders for review. Optical coherence tomography scans were graded by ophthalmologists via remote TeamViewer access.

MAIN OUTCOME MEASURE: Referral rates to an eye health professional and the rate of inadequate photographs.

RESULTS: Two hundred and twenty-two patients were included, with 80 in the control group and 142 in the intervention group. There was a significantly higher rate of inadequate fundus photographs in the intervention group (31.0% vs. 13.8%). Although there was a higher rate of referral to an eye health professional in the intervention group (39.6% vs. 30.0%), this was not significant. Diabetic retinopathy and maculopathy was evident in 32.3% and 12.0% of adequate fundus photographs, respectively. Diabetic macular oedema was present in 3.6% of optical coherence tomography scans.

CONCLUSIONS AND RELEVANCE: The combined optical coherence tomography fundus camera provided no advantage for diabetic retinopathy screening compared with fundus photography in an Australian programme. The rate of referral to an eye health professional was not reduced with a higher rate of inadequate fundus photographs.