Diabetes is a growing epidemic, brought on by unhealthy choices, and demanding medical care unlike any disease before. Telemedicine, allowing physicians to remotely monitor patients with diabetic retinopathy, can help meet that growing demand.
Noted physician Dr. Zimmer-Galler has stated that the DR telemedicine programs have been quite helpful to treat patients. They are highly effective, but because of the anticipated rise of diabetes cases in the next 15 years, they may not be enough. Her concern is that there will not be appropriate or adequate resources to properly evaluate and treat the rate of diabetic patients.
The lack of resources to properly treat diabetic patients isn’t the only concern Dr. Dimmer-Galler and other physicians have, however. The question of the validity of telemedicine practices is another. Presently, the American Telemedicine Asociation has 4 different levels of standard validity, starting with the presence of limited of minimal DR; presence of vision-threatening DR; the ability for providers to make clim=nical recommendations, and the Early Treatment DR Study photograph star=ndard (the highest level).
This validation is how telemedicine is judged to be a standard of care – currently, DR is determined by an in-person evaluation. Each DR treatment program, including telemedicine, must be evaluated to see how well it works, based on the “gold standard” of ETDRS photographs.
Telemedical treatment of diabetic retinopathy is expected to become more common in clinical practice. This should include primary-care automated image analysis using Nonmydriatic fundus cameras. With these, the images will be able to be transferred to readings centers for viewing, and then returned to the primary care physicians for diagnosis.
There is a concern that the rate of upgradeable images may affect telemedical treatment of DR. Currently, the minimum acceptable value for upgradeable images is 5%. There is no way with the current level of telemedicine, however, to diagnose diabetic macular edema (DME), which will require office visits. As the technology of telehealthcare improves, though, this may also be a viable option for remote diagnosis.
As it stands, telemedicine cannot be fully relied upon to treat DR or DME, although the technological improvement is increasing.