Expansion of a teleophthalmology program for diabetic retinopathy screening during the COVID19 pandemic

Purpose : The COVID-19 pandemic prompted efforts to encourage social distancing and minimize non-urgent in-person eye care. Here, we report the outcomes of a teleophthalmology program for diabetic retinopathy screening at an integrated health system in California that was expanded during the pandemic. Methods : We performed a retrospective review of patients who underwent remote retinal imaging as part of a teleophthalmology program for diabetic retinopathy (DR) screening using Current Procedural Terminology (CPT) codes 92227 and 92228 at the University of California, Davis Health system between May 31st , 2019 and June 8th , 2021. Retinal images were captured at primary care locations using a Topcon NW400, Nikon RetinaStation, or Optos Primary fundus cameras, and image grading were performed by trained ophthalmologists or optometrists using a store-and-forward method. Patient records were reviewed to collect demographic, follow-up, and clinical outcomes information. Results : During COVID19 pandemic, the teleophthalmology program screened 570 individuals (mean age 63.2 ± 13.7). There was a significant increase in the number of patients screened per month prior to and following the COVID-19 lock-down in March 2020 (5.0 ± 3.1 patients screened per month prior to and 39.1 ± 34.8 patients per month following, P = 0.0004). Among these, 204 patients received a recommendation for in-person eye care referral, of which 127 received a referral to the UC Davis Eye Center, 85 appointments were scheduled, and 82 patients were followed in person, with a median time of 108 days between screening and in-person follow-up. Follow-up rates were generally lower during the initial months after the pandemic and increased over time. Among the patients who followed in person (mean age 63.9 ± 13.8), 10% of eyes had mild non-proliferative DR (NPDR), 5% had moderate NPDR, 3% had severe NPDR, 2% had PDR, and 4% had diabetic macular edema (DME), with similar proportions before and after the COVID-19 lockdown. Conclusions : Expansion of a teleophthalmology program during the COVID19 pandemic demonstrated improved DR screening rates, increased referrals, and improved follow-up for diabetic eye care at an integrated health system in Northern California.

Utilization and insurance coverage of tele-retinal imaging during the COVID-19 pandemic

Purpose : Greater utilization and insurance coverage for tele-retinal screening during the COVID-19 pandemic in 2020 may enhance awareness and expand remote retinal imaging services. In this study, we performed a retrospective, cross-sectional analysis of utilization and insurance payments of tele-retinal imaging services in the United States in 2020. Methods : We examined remote retinal imaging utilization and insurance payments from January 1, 2020, to December 31, 2020, using the OptumLabs® Data Warehouse (OLDW), a comprehensive database of de-identified administrative claims for commercial and Medicare Advantage enrollees in the U.S. We evaluated frequency of claims and insurance payment for services using Current Procedural Terminology codes 92227 and 92228 for remote eye imaging by any provider, and 92250 for fundus photography by non-eye care providers. Results : Use of remote retinal imaging declined rapidly from 3627 claims in February 2020 to 1414 claims in April 2020, but returned to 3133 claims by December 2020, similar to pre-pandemic levels in 2019 (2841 ± 174.8 claims). Proportion of insurance payments for remote imaging increased temporarily from 47.4% in February to 56.7% in April, then returned to 45.9% in December. Conclusions : Utilization of tele-retinal imaging declined steeply while insurance coverage increased during the initial COVID-19 lockdown in 2020, but returned to pre-pandemic levels by end-of-year. Changes in utilization and relaxed restrictions on insurance reimbursements for remote retinal imaging during the COVID-19 pandemic were not sustained.