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J Diabetes Res ; 2020: 9036847, 2020.
Article in English | MEDLINE | ID: covidwho-894922


Recently, telemedicine has become remarkably important, due to increased deployment and development of digital technologies. National and international guidelines should consider its inclusion in their updates. During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments has made telemedicine the safest interactive system between patients, both infected and uninfected, and clinicians. A few potential evidence-based scenarios for the application of telemedicine have been hypothesized. In particular, its use in diabetes and complication monitoring has been remarkably increasing, due to the high risk of poor prognosis. New evidence and technological improvements in telemedicine application in diabetic retinopathy (DR) have demonstrated efficacy and usefulness in screening. Moreover, despite an initial increase for devices and training costs, teleophthalmology demonstrated a good cost-to-efficacy ratio; however, no national screening program has yet focused on DR prevention and diagnosis. Lack of data during the COVID-19 pandemic strongly limits the possibility of tracing the real management of the disease, which is only conceivable from past evidence in normal conditions. The pandemic further stressed the importance of remote monitoring. However, the deployment of device and digital application used to increase screening of individuals and monitor progression of retinal disease needs to be easily accessible to general practitioners.

Coronavirus Infections/epidemiology , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/therapy , Pandemics , Pneumonia, Viral/epidemiology , Telemedicine , Betacoronavirus/physiology , COVID-19 , Cost-Benefit Analysis , Diabetic Retinopathy/epidemiology , Humans , Mass Screening/economics , Mass Screening/methods , Mass Screening/organization & administration , Mass Screening/trends , Ophthalmology/economics , Ophthalmology/methods , Ophthalmology/organization & administration , Ophthalmology/trends , SARS-CoV-2 , Telemedicine/economics , Telemedicine/organization & administration , Telemedicine/standards , Telemedicine/trends
Curr Opin Ophthalmol ; 31(5): 357-365, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-703543


PURPOSE OF REVIEW: Diabetic retinopathy is the most common specific complication of diabetes mellitus. Traditional care for patients with diabetes and diabetic retinopathy is fragmented, uncoordinated and delivered in a piecemeal nature, often in the most expensive and high-resource tertiary settings. Transformative new models incorporating digital technology are needed to address these gaps in clinical care. RECENT FINDINGS: Artificial intelligence and telehealth may improve access, financial sustainability and coverage of diabetic retinopathy screening programs. They enable risk stratifying patients based on individual risk of vision-threatening diabetic retinopathy including diabetic macular edema (DME), and predicting which patients with DME best respond to antivascular endothelial growth factor therapy. SUMMARY: Progress in artificial intelligence and tele-ophthalmology for diabetic retinopathy screening, including artificial intelligence applications in 'real-world settings' and cost-effectiveness studies are summarized. Furthermore, the initial research on the use of artificial intelligence models for diabetic retinopathy risk stratification and management of DME are outlined along with potential future directions. Finally, the need for artificial intelligence adoption within ophthalmology in response to coronavirus disease 2019 is discussed. Digital health solutions such as artificial intelligence and telehealth can facilitate the integration of community, primary and specialist eye care services, optimize the flow of patients within healthcare networks, and improve the efficiency of diabetic retinopathy management.

Artificial Intelligence , Diabetic Retinopathy/diagnosis , Cost-Benefit Analysis , Health Services Accessibility , Humans , Ophthalmology/economics , Ophthalmology/trends , Telemedicine/economics , Telemedicine/methods