JMIR Publications

ABSTRACT

Background:

Undiagnosed ocular and systemic diseases are common in primary care populations, and many can be detected through retinal imaging before symptoms develop. Asynchronous store-and-forward teleophthalmology offers a scalable way to integrate eye screening into primary care, yet its broader impact beyond diabetic retinopathy detection remains underexplored.

Objective:

This study evaluated the outcomes of asynchronous store-and-forward teleophthalmology screening in a primary care clinic, including detection and triage of ocular conditions and subsequent changes in eye and systemic management.

Methods:

This was a retrospective cross-sectional analysis of the first 200 patients screened. Each patient underwent non-mydriatic external and posterior eye imaging, which was reviewed by a remote reading eye clinician. Reports included findings, triage decisions (routine monitoring vs in-person referral), and management recommendations. Subsequent changes in care were extracted from primary care and in-person specialist consult notes.

Results:

Of 200 patients (mean age 62, range 11-100), 71.5% had positive eye findings, and 40% were referred for in-person eye exams. Only 9% of referrals were for diabetic retinopathy; most were for glaucoma suspects, age-related macular degeneration, cataracts, or other ocular indicators. Image quality was high: 98% of fundus images were at least partially adequate. Among 35 patients with documented follow-up, 88% of in-person eye evaluations confirmed the remote findings. Eye management changes were initiated in 11 patients, while systemic changes occurred in 70, including new prescriptions for AREDS2 vitamins, antihypertensives, diabetes medications, and lipid-lowering agents.

Conclusions:

Asynchronous teleophthalmology screening in a primary care setting effectively identified both ocular and systemic conditions, leading to meaningful changes in care. The low rate of diabetic retinopathy among referrals highlights the broader diagnostic value of retinal imaging beyond diabetes management. This care model offers a scalable, high-yield strategy for proactive disease detection and interdisciplinary intervention at the primary care level.