Original articleOphdiat®: Five-year experience of a telemedical screening programme for diabetic retinopathy in Paris and the surrounding areaOphdiat® : cinq ans d’expérience d’un programme de dépistage de rétinopathie diabétique par télémédicine à Paris et en Île-de-France
Introduction
Screening for diabetic retinopathy helps towards the early diagnosis of advanced stages of the disease, which is of crucial importance for choosing the appropriate treatment and preventing further visual loss [1], [2]. According to both international recommendations and those of the French National Health Authority, the Haute Autorité de Santé (HAS), an annual examination of the ocular fundus should be done in diabetic patients who have either no documented or mild retinopathy [1], [3], [4], [5], [6]. Screening for retinopathy should be done by retinography, as it is a more sensitive technique than indirect ophthalmoscopy [7], [8], [9]. Although retinal photographs may be taken by doctors and paramedical personnel outside of ophthalmological centres, the photos have to be interpreted by a retinal specialist [10]. The characteristics of diabetic retinopathy, combined with the progress made in data-transfer systems, constitute an optimal basis for telemedicine [11]. Telemedical networks that screen for diabetic retinopathy are, in fact, already working in several countries, and good results have been reported [12], [13], [14], [15], [16], [17], [18]. However, demographic studies have found that only 40 to 60% of the diabetic population undergoes regular ocular screening [19], [20].
The present report describes our 5-year experience of the Ophthalmology Diabetes Telemedicine Network (Ophdiat®), which covers Paris and the surrounding area known as the Île-de-France.
Section snippets
Methods
The Ophdiat® network was created in 2004 with the aim of improving the ophthalmological screening of diabetic patients in the Île-de-France area. The screening centres that make up this network are linked via a central server to an ophthalmological reading centre. The organization and details of the network have been described elsewhere [21] and, hence, are only briefly covered here.
From 24 June 2004 to 31 December 2009, an ever-increasing number of hospitals and primary healthcare centres (
Results
By 31 December 2009, 51,741 screening examinations had been completed for 38,596 patients in the Île-de-France area. During the 5.5 years of the study period beginning in June 2004, the number of screening examinations and new patients increased constantly (Fig. 2).
Around 73% of all patients were diagnosed as having mild DR or none at all, and annual screening by a funduscopic camera was recommended. However, not all of these patients came to be screened the year after their initial
Discussion
Telemedicine is considered an optimal means of screening for DR [11]. The Ophdiat® network was designed to cover Paris and the entire surrounding Île-de-France area, which together comprise nearly 12 million inhabitants (11,659,260). According to a representative national sample of diabetic patients for the period 2007–2010, the prevalence of diabetes in this population was 3 to 6% and expected to increase [20]. However, the number of ophthalmologists [n = 1358, including 568 who are intra muros
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgements
The Ophdiat® network is supported by the Organisme pour la Prévention de la Cécité (Organization for the Prevention of Blindness) and the Valentin Haüy Association. The following institutions are participants in the Ophdiat® network:
- •
hôpital Avicenne, Bobigny: Pr G. Réach, Dr R. Cohen, Diabetology Department; Pr G. Chaine, Ophthalmology Department;
- •
hôpital Bichat, Paris: Pr M. Marre, Diabetology Department; Pr I. Cochereau, Ophthalmology Department;
- •
hôpital Cochin, Paris: Pr J. Timsit, Diabetology
References (35)
- et al.
Screening for diabetic retinopathy in a rural French population with a mobile non-mydriatic camera
Diabetes Metab
(2009) - et al.
The prevalence of diabetic retinopathy as identified by teleophthalmology in rural Alberta
Can J Ophthalmol
(2010) - et al.
Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases
Ophthalmology
(2003) - et al.
OPHDIAT: a telemedical network screening system for diabetic retinopathy in the Île-de-France
Diabetes Metab
(2008) - et al.
Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales
Ophthalmology
(2003) - et al.
A new grading system from color fundus photographs for screening for diabetic retinopathy
J Fr Ophtalmol
(2007) - et al.
OPHDIAT: quality-assurance programme plan and performance of the network
Diabetes Metab
(2008) - et al.
Prevalence of diagnosed type 2 diabetes mellitus in the French general population: the INSTANT study
Diabetes Metab
(2009) - et al.
Epidemiology of diabetic retinopathy: expected vs reported prevalence of cases in the French population
Diabetes Metab
(2009) - et al.
Effectiveness and safety of screening for diabetic retinopathy with two nonmydriatic digital images compared with the seven standard stereoscopic photographic fields
Can J Ophthalmol
(2003)