Digital imaging technology in the primary care visit can significantly improve screening rates for diabetic retinopathy over conventional methods, can increase access to recommended diabetic eye care and can focus specialty care on medically indigent patients with greatest need, according to a retrospective cohort study by Tennessee’s Vanderbilt University.

The study included all diabetic patients aged 18 years and older (495 participants) seen at one community clinic between September 1, 2003 and August 31, 2004. Patients were offered ophthalmology referral or digital screening. Those choosing referral received the next available appointment (within three months) at the Vanderbilt Eye Clinic; patients choosing digital screening were screened during the visit.

Retinal screening was documented for 293 patients (59.2 percent), a significant improvement compared with the 23 percent baseline rate. Of 293 patients screened, 92 (31.4 percent) were screened in ophthalmology and 201 (68.6 percent) were digitally screened. Among the 201 digitally screened patients, 104 (51.7 percent) screened negative and were advised to rescreen in one year, 75 (37.3 percent) screened positive and were non-urgently referred to ophthalmology and 22 (11.0 percent) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5 percent. Referral status was associated with race/ethnicity, with whites more likely to screen negative than non-whites (62.4 vs. 47.8 percent). Sight-threatening disease among non-whites (14.7 percent) was more than double that observed for whites (5.9 percent).

An increased rate of photodynamic therapy (PDT), presumably for subfoveal age-related macular degeneration (AMD) occurs 12 to 18 months after cataract surgery, according to an observational population-based retrospective case-control study by Israeli researchers.

The study included all members in a district of the largest health maintenance organization (HMO) in Israel older than 50 years on January 1, 2001, who did not terminate their membership through May 31, 2005: a total of 139,894 participants. Investigators documented all PDT procedures for AMD performed in the study population between January 1, 2001 and May 31, 2005 (283 patients) and all cataract surgeries performed between January 1, 2001 and December 31, 2003 (5,913 patients). They extracted clinical information from the chronic disease registry of the HMO, as well as demographic and socioeconomic information. For each patient that underwent cataract surgery, five HMO members matched in age, gender, chronic diseases (systemic hypertension, diabetes, hyperlipemia and ischemic heart disease), place of residence, country of birth and socioeconomic status who did not undergo cataract surgery were randomly chosen as controls (29,565 participants).

Fifty cataract patients (0.85 percent) and 94 control cases (0.32 percent) underwent PDT after cataract surgery. A significant rise in PDT rate was noticed in cataract patients compared to controls during the first six months after surgery. Between six and 12 months postoperatively, PDT rates were similar in both groups, but a more significant rise in PDT rates occurred between 12 and 18 months after surgery. The Kaplan-Meier PDT-free survival curve of cataract patients was significantly worse than that of the controls. The hazard ratio for cataract patients compared to controls to undergo PDT after surgery was 2.7. The most significant factors to reduce the time to PDT were advanced age, having had cataract surgery, place of birth, socioeconomic status and hyperlipidemia.