Improving diabetic retinopathy screening in Africa: patient satisfaction with teleophthalmology versus ophthalmologist-based screening

ABSTRACT

To assess patient preference for diabetic retinopathy [DR] screening with teleophthalmology or face-to-face ophthalmologist evaluation in Nairobi, Kenya. Fifty seven diabetic patients from a one-stop multidisciplinary diabetic clinic [consisting of a diabetologist, nurse educator, foot specialist, nutritionist, ophthalmologist, and neurologist] in Nairobi, Kenya were included if they had undergone both a teleophthalmology [stereoscopic digital retinal photographs graded by an ophthalmologist remotely] and a traditional clinical screening exam [face to face examination]. A structured questionnaire with a 5-point Likert scale was developed in both English and Swahili. The questionnaire was administered over the telephone. Ten questions were used to compare patient experience and preferences between teleophthalmology and a traditional clinical examination for DR. A mean score >3.25 on the Likert scale was considered favourable. Successfully telephone contact was possible for 26 [58% male, 42% females] of the 57 patients. The mean ages of the male and female patients were 52.4 and 46.5 years respectively. Patients were satisfied with their teleophthalmology examination [mean 4.15 +/- 0.97]. Patients preferred the teleophthalmology option for future screenings [mean 3.42 +/- 1.52]. This preference was driven primarily by convenience, reduced examination time, and being able to visualize their own retina. In this study, diabetic patients preferred a teleophthalmology based screening over a traditional ophthalmologist-based screening. The use of teleophthalmology in Africa warrants further study and has the potential to become the screening model of choice. Cost effectiveness in comparison to an ophthalmologist-based screening also requires evaluation