Remote screening for age-related macular degeneration (AMD) using a nonmydriatic digital color fundus camera: Disrupted patient care pathways

Introduction/objectives/aim

Age-related macular degeneration (AMD) is the leading cause of visual acuity loss in patients aged 65 and above, with the number of cases expected to increase over the next decade. We present the results of an AMD screening trial using a nonmydriatic digital color fundus camera and telemedicine, and report the impact this screening has on the medical course of positive patients.

Material and method

Over two years, color fundus photographs were taken for patients consulting health examination centers and transmitted electronically to an ophthalmology department. The rates of occurrence of different grades of AMD were then calculated.

Positive patients were then contacted by telephone to complete a questionnaire.

Results/observations

A total of 1448 photos from 726 patients were interpreted, of which 82% were gradable. Age-related macular degeneration was diagnosed for 15.3% (111) of the patients, with 10.2% (74), 3.4% (25), 1.1% (8), and 0.5% (4) at grades 1, 2, 3, and 4, respectively.

Among the positive patients, 74 agreed to participate in the survey. The mean time since their last ophthalmologic exam was seven years and 43 only consulted their ophthalmologist as recommended, on average 31 days after the initial screening. For 32 of these patients (74%), the face-to-face diagnostic was also positive. Prophylactic treatment was initiated for 5 patients, and 2 patients received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.