Author Block: Jessica Cao, Rebecca Merritt, Lisa Kha, Tina Felfeli, Olivera Sutakovic, Michael H. Brent

Author Disclosure Block: J. Cao: None. R. Merritt: None. L. Kha: None. T. Felfeli: None. O. Sutakovic: None. M.H. Brent: Membership on advisory boards or speakers’ bureaus; Novartis Canada, Bayer Canada, Allergan Canada (Advisory Board). Funded grants or clinical trials; Novartis Canada, Bayer Canada, Roche Canada, Regeneron (Funded for clinical trials).

Abstract Body:

Purpose: Diabetic retinopathy (DR) is the leading cause of blindness in working age Canadians. However, screening rates remain low with approximately 40% of diabetic individuals in Ontario not receiving regular eye exams. Surprisingly, large cities were found to have the lowest screening rates. The Toronto Tele-Retinal Screening Program (TTRSP) was initiated in 2013 to target regions with low screening rates. This project presents sociodemographic data of TTRSP participants and screening trends over the past 5 years in order to assess the efficacy of TTRSP in identifying preventable disease in an inner-city population.

Study Design: Retrospective case series of screening data.

Methods: Electronic medical records of all adults with diabetes mellitus screened through the TTRSP from September 2013 to March 2019 across 15 urban screening sites were obtained. Sociodemographic data of screened patients, including income, education, and ethnic background were collected from April 2017 to March 2019. OCT and colour fundus photographs were graded for presence or absence of DR and diabetic macular edema (DME). Statistics were conducted using SPSS with significance p=0.05.

Results: 1374 patient screens were completed for 973 unique patients with average age of 55.9 ± 12.4 years and diabetes duration of 7.1 ± 7.4 years. 265 patients had repeat screenings through the program, up to five visits over the study period. Of all screens, 26% showed some degree of DR and 4% were also found to have vision-threatening DME. 15% of patients had never had an eye exam. Self-reported sociodemographic data was available from 587 patients, representing 60.3% of program participants. 82% were born outside of Canada, and 17% did not have provincial health coverage. 77% had concurrent chronic illness, disability, drug/alcohol dependence, or mental illness. Only one-third of patients had some level of post-secondary education, compared to over half of the Canadian population. Despite a high non-response rate (48%) for income data, over half of completed responses reported an annual household income under $15,000. Patients with annual household income under $25,000, were significantly more likely than the remainder of patients to have some degree of DR (p=0.04) and DME (p=0.01). These patients were also more likely to have never had a previous eye exam (p=0.05).

Conclusions: Tele-retinal screening programs can effectively identify treatable DR and DME. The TTRSP program is successful in targeting vulnerable inner-city populations in Toronto with low DR screening rates and bringing care to many who would have otherwise not received screening.