Feasibility of using the TOSCA telescreening procedures for diabetic retinopathy

  1. S. Luzio1,*,
  2. S. Hatcher1,
  3. G. Zahlmann2,
  4. L. Mazik3,
  5. M. Morgan4,
  6. B. Liesenfeld5,
  7. T. Bek6,
  8. H. Schuell2,
  9. S. Schneider2,
  10. D. R. Owens1,
  11. E. Kohner7

Article first published online: 25 JUN 2004

DOI: 10.1111/j.1464-5491.2004.01305.x

Issue

Diabetic Medicine

Diabetic Medicine

Volume 21, Issue 10, pages 1121–1128, October 2004

Additional Information

How to Cite

Luzio, S., Hatcher, S., Zahlmann, G., Mazik, L., Morgan, M., Liesenfeld, B., Bek, T., Schuell, H., Schneider, S., Owens, D. R. and Kohner, E. (2004), Feasibility of using the TOSCA telescreening procedures for diabetic retinopathy. Diabetic Medicine, 21: 1121–1128. doi: 10.1111/j.1464-5491.2004.01305.x

Author Information

  1. 1

    Diabetes Research Unit, Penarth, UK,

  2. 2

    Siemens MED, Erlangen, Germany

  3. 3

    Charles University Hospital, Prague, Czech Republic

  4. 4

    Irish Diabetic Retinopathy Study Group, Dublin, Eire

  5. 5

    BruderKrankenhaus, Trier, Germany

  6. 6

    University Hospital, Aarhus, Denmark

  7. 7

    ICSTM, London, UK

*Stephen Luzio, Diabetes Research Unit, Llandough Hospital, Penlan Road, Penarth, Cardiff, UK. E-mail: luzio@cardiff.ac.uk

Publication History

  1. Issue published online: 22 SEP 2004
  2. Article first published online: 25 JUN 2004
  3. Accepted 11 December 2003

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Keywords:

  • diabetic retinopathy;
  • quality assurance;
  • screening;
  • telemedicine

Abstract

Aims  The TOSCA project was set up to establish a tele-ophthalmology service to screen for diabetic retinopathy (DR) in Europe. The aim of this study was to determine the feasibility of establishing telemedicine-based digital screening for detecting DR and to evaluate the satisfaction of both patients and healthcare professionals with the screening procedures used within the TOSCA project.

Methods  The study was a non-randomized, multicentre study carried out in four different countries over a period of 3 months.

Patients  (n = 390) with diabetes aged > 12 years were included. Two digital retinal images per eye (macular and nasal) were taken and exported to a central server. Patients were asked to complete a questionnaire to assess satisfaction. Accredited graders carried out grading remotely and the results were reported back to the referring centre. Previously graded patient data chosen randomly to represent examples of both DR and no DR were also sent anonymously to the grading centre at a frequency of approximately every 10 patients.

Results  Most (99%) of the images were assessable enabling a retinopathy grade to be assigned to the patient. Patients found the retinal photography procedures acceptable; only 6% in one centre would not recommend the procedure. Healthcare professionals (photographers and graders) were also satisfied with the overall procedures. The average time taken to grade each patient was approximately 5 min.

Conclusions  This study demonstrated that it is feasible to electronically transmit and grade retinal images remotely using the TOSCA process. Built-in quality assurance procedures proved acceptable.

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