Integrating Nursing-Teleophthalmology Improves Diabetic Retinopathy Screening in Primary Healthcare, Reducing Unnecessary Referrals to Specialist Healthcare.
Jacira Xavier de Carvalho, Fernando K Malerbi, Silvia Ferreira Bortoto and 5 others
PMID 40235053WHAT IT FOUND
Nurses captured retinal images, and remote reading allowed analysis in 584 of 779 people with type 2 diabetes; 345 were referred and 56% stayed in primary care.
Key findings
01Nursing-teleophthalmology integration enabled retinal analysis in 584 of 779 participants.
02A total of 345 participants were referred to specialized care, including 150 with diabetic retinopathy and 195 with ungradable images, and 56% stayed in primary care.
03From day seven onward, more than 80% of images allowed a clinical decision, and median examination duration was 2 min.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one primary healthcare centre in São Paulo, so the results may not apply to other services. It used convenience sampling and had no comparison group, so it cannot show that nurse teleophthalmology caused fewer unnecessary referrals than usual care. 25% of images were ungradable, and all ungradable images were referred, so many referrals were not confirmed diabetic retinopathy. Only one retina specialist read the images, and the study was not registered. It included only people with type 2 diabetes, so it says nothing about type 1 diabetes. Follow-up happened near the start of the COVID-19 pandemic, only 71.6% of referrals were tracked, 14 participants died, and median waiting time was 180 days.
Declared interests
One author, FKM, is a medical consultant for Phelcom Technologies, the company named as the source of the Eyer portable retinal camera and EyerCloud platform used in the study. All other authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that nurse teleophthalmology reduces unnecessary referrals compared with usual care. This was a single-centre service evaluation with no comparison group, and 195 participants were referred because images were ungradable rather than because diabetic retinopathy was present.