While telemedicine remains a hot button issue in some circles, it can be a cost effective screening tool for patients with diabetic retinopathy and glaucoma compared to in-office clinical exams, a new study reports.

Researchers reviewed 16 studies that included partial or full economic evaluations of screenings or detections of diabetic retinopathy, glaucoma and other eye diseases versus the costs of face-to-face exams. Out of these, 12 studies were on diabetic retinopathy, two focused on glaucoma, and the remaining two encompassed other eye diseases. The investigators factored in costs for traditional exams such as reimbursement rates, travel/transportation and staff labor. Costs for teleophthalmology were training, equipment, annual maintenance, software and referrals for a traditional exam when indicated.

The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The patient pool size varied from 110 to 3,500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilization of the equipment.

Researchers found all the studies showed cost-savings with teleophthalmology

compared with traditional exams. Also of note, they reported the number of patients screened by teleophthalmology—coupled with a high prevalence of disease—increased cost-effectiveness.

The study reported teleophthalmology for diabetic retinopathy yielded the most cost savings when compared with traditional clinical exams. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates.  Additionally, teleophthalmology for glaucoma was more cost-effective compared with in-person exams. Similarly, an increasing number of glaucoma patients targeted for screening yielded greater cost savings.

"Teleophthalmology holds the promise of improving service disparities in underserved locations with historically limited access to specialist services and increasing patient participation due to increased convenience,” the researchers said in their paper.     Teleophthalmology also reduces the number of patients that require direct referral for examination avoiding unnecessary visits, which is most beneficial in rural locations due to reduction of travel cost from remote and geographically isolated areas, they added.

“After accounting for initial capital costs, teleophthalmology was shown to be the cost-saving alternative compared with traditional ophthalmologist examination regardless of geographical setting and with evidence of acceptability among patients and providers.”

Sharafeldin N, Kawaguchi A, Sundaram A, et. al. Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults. Br J Ophthalmol. 2018 Nov;102(11)1485-91.