A Multi-Center Diabetes Eye Screening Study in Community Settings: Study Design and Methodology

ABSTRACT

Purpose: Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years within the United States. The Innovative Network for Sight Research group (INSIGHT) designed the Diabetic Eye Screening Study (DESS) to examine the feasibility and short-term effectiveness of non-mydriatic diabetic retinopathy (DR) screening for adults with diabetes in community-based settings.

Methods: Study enrollment began in December 2011 at four sites: an internal medicine clinic at a county hospital in Birmingham, Alabama; a Federally-qualified community healthcare center in Miami-Dade County, Florida; a university-affiliated outpatient pharmacy in Philadelphia, Pennsylvania; and a medical home in Winston-Salem, North Carolina. People 18 years or older with previously diagnosed diabetes were offered free DR screening using non-mydriatic retinal photography that was preceded by a brief questionnaire addressing demographic information and previous eye care use. Visual acuity was also measured for each eye. Images were evaluated at a telemedicine reading center by trained evaluators using the National Health System DR grading classification. Participants and their physicians were sent screening report results and telephoned for a follow-up survey 3 months post-screening to determine whether participants had sought follow-up comprehensive eye care and their experiences with the screening process.

Results: Target enrollment at each site was a minimum of 500 persons. Three of the four sites met this enrollment goal.

Conclusion: The INSIGHT/DESS is intended to establish the feasibility and short-term effectiveness of DR screening using non-mydriatic retinal photography in persons with diabetes who seek services in community-based clinic and pharmacy settings.

KEYWORDS:

• Diabetes
• eye screening
• methodology
• study design
• tele-ophthalmology

Acknowledgments

Cameras were donated for the study duration by Nidek Inc., Fremont, CA.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was funded by the Centers for Disease Control and Prevention through cooperative agreements with Johns Hopkins University 5U58DP002653), the University of Alabama at Birmingham (5U58DP002651), the University of Miami (5U58DP002652), and the Wills Eye Hospital (5U58DP002655).

Supplemental funding was provided as indicated, listed by institution: Johns Hopkins University: Alcon Research Institute award funds to Dr Friedman; University of Alabama at Birmingham: EyeSight Foundation of Alabama, Research to Prevent Blindness Inc., The Buck Trust.

*A Supplemental Appendix listing the INSIGHT Study Group members can be accessed on the publisher’s website.

Additional information

Funding

This study was funded by the Centers for Disease Control and Prevention through cooperative agreements with Johns Hopkins University 5U58DP002653), the University of Alabama at Birmingham (5U58DP002651), the University of Miami (5U58DP002652), and the Wills Eye Hospital (5U58DP002655).