Prevalence of Potentially Sight-Threatening Pathology Detected by Non-Mydriatic Fundus Photography in a National Diabetic Screening Platform.

Abstract

Background and objective: Hundreds, if not thousands, of non-mydriatic fundus images are acquired in primary care offices daily and uploaded for remote grading by ophthalmologists, retina specialists, and/or artificial intelligence. No prior studies of this magnitude have explored the yield of sight-threatening pathology identified on these platforms. The goal of this study is to report on the prevalence of potentially sight-threatening pathology during a 9-year experience with a single national telemedicine platform.

Patients and methods: This was a multicenter, non-interventional, non-masked, non-randomized, retrospective review of 1,190,754 consecutive gradable bilateral fundus exams obtained on non-mydriatic fundus cameras in the primary care setting and uploaded to a national platform. All images were interpreted by board-certified ophthalmologists and/or fellowship-trained retinal specialists.

Results: In total, 44% of gradable exams were obtained on the Center Vue DRS camera, 38% on the Volk Pictor Plus, and the remainder on other cameras. Of these, 381,023 exams (32%) had evidence of pathology. Suspected moderate, severe, and proliferative diabetic retinopathy were present on 101,714 (9%), 23,988 (2%), and 30,515 (3%) exams, respectively. Macular edema was present on 27,712 exams (2%). Epiretinal membrane and age-related macular degeneration (total of exudative and dry) were present on 14,306 (1%) and 36,298 (3%) exams, respectively. Suspected glaucoma was present on 70,154 exams (6%). Papilledema, melanoma, posterior uveitis, and retinal detachment were reported in an "other pathology" category that included 116,762 exams (10%).

Conclusion: Routine non-mydriatic fundus screening in the primary care setting detects diabetic and non-diabetic pathology in approximately one-third of patients.