Effectiveness of Tele-medicine in Identifying Diabetic Retinopathy Cases Attending Diabetologists' Clinics Compared to the Conventional Referral System
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Diabetic Retinopathy
- Sponsor
- Aravind Eye Care System
- Enrollment
- 801
- Locations
- 1
- Primary Endpoint
- Proportion of patients with confirmed Diabetic Retinopathy (DR) diagnosed at the eye hospital
- Status
- Completed
- Last Updated
- 11 years ago
Overview
Brief Summary
The aim of this study is to compare the effectiveness of identifying diabetic retinopathy using tele-medicine based Digital Retinal Imaging in Diabetes Clinics with that of the conventional referral system.
Hypothesis: Tele-medicine based digital retinal imaging involving a diabetes centre will identify proportionately more diabetic patients with DR and lead to higher acceptance rate with subsequent ophthalmic referral and management
Detailed Description
The design is a cluster randomized trial of tele-medicine versus usual care in diabetic patients. The primary outcome of the study is the proportion of patients with confirmed DR at Aravind Eye Hospital (AEH). DR will be graded using the International Clinical Diabetic Retinopathy Disease Severity Scale. A sample size of 616 patients in both arms is required to detect a risk ratio of 1.8 or above at 90% power, 1% alpha and a design effect of 2. Eight clinics will be recruited and equally randomized to tele-medicine or usual care stratified by distance from AEH. Inclusion criteria include a confirmed diagnosis of diabetes, age over 50, no retinal exam in the previous year. In the tele-medicine arm patients will be offered fundus imaging and patients diagnosed with DR or probable DR will be counselled to visit AEH to confirm DR. In the usual care arm, the eligible patients will be counselled and referred to undergo an eye examination at AEH. In both the arms the counselling and the awareness creation materials will be standardized. Fundus imaging will be offered at the end of the study to those who refuse initially and all those in the usual arm who did not attend AEH.
Investigators
Sanil Joseph
Faculty
Aravind Eye Care System
Eligibility Criteria
Inclusion Criteria
- •Diabetic patients (as per ICD-9 code 250) in the age group of ≥50 years
Exclusion Criteria
- •Patients \<50 years of age
- •Already enrolled as study patients at the diabetes centre
- •Patients screened for DR in free camps organized by the diabetes centre
- •Diabetic patients who underwent retinal examination in the previous year prior to this intervention
- •Patients with disability (physical or mental) who have difficulty in travelling to the eye hospital
Outcomes
Primary Outcomes
Proportion of patients with confirmed Diabetic Retinopathy (DR) diagnosed at the eye hospital
Time Frame: 6 months
Out of the patients referred from the diabetes clinics to the eye hospital, the number of patients with confirmed DR will be measured. This proportion will be compared between the two arms.
Secondary Outcomes
- The severity of diabetic retinopathy (DR)(6 months)
- The acceptance rate for referral in each arm(6 months)
- Proportion of patients eligible for referral who had DR and who did not attend(6 months)