{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:28Z","timestamp":1787022148963,"version":"build-2736575974"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001607","name":"Eye and Ear Foundation of Pittsburgh","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001607","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Diabetic Retinopathy stands as a leading cause of irreversible blindness, necessitating frequent examinations, especially in the early stages where effective treatments are available. However, current examination rates vary widely, ranging from 25\u201360%. This study scrutinizes the Point-of-Care Diabetic Retinopathy Examination Program at the University of Pittsburgh\/UPMC, delving into its composition, evolution, challenges, solutions, and improvement opportunities. Employing a narrative approach, insights are gathered from key stakeholders, including ophthalmologists and staff from primary care clinics. A quantitative analysis from 2008 to 2020 provides a comprehensive overview of program outcomes, covering 94 primary care offices with 51 retinal cameras. Program components feature automated non-mydriatic 45\u00b0 retinal cameras, a dedicated coordinator, rigorous training, and standardized workflows. Over this period, the program conducted 21,960 exams in 16,458 unique individuals, revealing a diverse population with an average age of 58.5 and a balanced gender distribution. Average body mass index (33.96\u00b18.02 kg\/m2) and hemoglobin A1c (7.58%\u00b11.88%) surpassed normal ranges, indicating prevalent risk factors for diabetes-related complications. Notably, 24.2% of patients underwent more than one exam, emphasizing program engagement. Findings indicated that 86.3% of exams were gradable, with 59.0% within normal limits, 12.1% showing some evidence of diabetic retinopathy, and 6.4% exhibiting vision-threatening diabetic retinopathy. Follow-up appointments with ophthalmologists were recommended in 31.5% of exams due to indeterminate results, positive diabetic retinopathy (\u2265moderate or macular exudate), or other findings like age-related macular degeneration or suspected glaucoma. The program demonstrated high reproducibility across diverse healthcare settings, featuring a sustainable model with minimal camera downtime, standardized workflows, and financial support from grants, health systems, and clinical revenues. Despite COVID-19 pandemic challenges, this research emphasizes the program\u2019s reproducibility, user-friendly evolution, and promising outcomes. Beyond technical contributions, it highlights human factors influencing program success. Future research could explore adherence to follow-up ophthalmological recommendations and its associated factors.<\/jats:p>","DOI":"10.1371\/journal.pone.0305586","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T13:23:17Z","timestamp":1720790597000},"page":"e0305586","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comprehensive insights into a decade-long journey: The evolution, impact, and human factors of an asynchronous telemedicine program for diabetic retinopathy screening in Pennsylvania, United States"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0224-3482","authenticated-orcid":true,"given":"Francisco J.","family":"Bonilla-Escobar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony I.","family":"Ghobrial","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5904-0742","authenticated-orcid":true,"given":"Denise S.","family":"Gallagher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Eller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan L.","family":"Waxman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"issue":"6","key":"pone.0305586.ref001","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1016\/S2214-109X(13)70113-X","article-title":"Causes of vision loss worldwide, 1990\u20132010: a systematic analysis","volume":"1","author":"RR Bourne","year":"2013","journal-title":"Lancet Glob Health"},{"key":"pone.0305586.ref002","first-page":"CD012314","article-title":"Different lasers and techniques for proliferative diabetic retinopathy","volume":"3","author":"T Moutray","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0305586.ref003","first-page":"CD007419","article-title":"Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis","volume":"6","author":"G Virgili","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"pone.0305586.ref004","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4103\/0970-0218.91324","article-title":"Role of early screening for diabetic retinopathy in patients with diabetes mellitus: an overview","volume":"36","author":"P Vashist","year":"2011","journal-title":"Indian J Community Med"},{"issue":"15","key":"pone.0305586.ref005","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23158513","article-title":"New Insights into Treating Early and Advanced Stage Diabetic Retinopathy","volume":"23","author":"R Sim\u00f3","year":"2022","journal-title":"Int J Mol Sci"},{"issue":"5","key":"pone.0305586.ref006","first-page":"75","article-title":"Diabetic retinopathy: Early diagnosis and effective treatment","volume":"107","author":"AN Kollias","year":"2010","journal-title":"Dtsch Arztebl Int"},{"issue":"1","key":"pone.0305586.ref007","doi-asserted-by":"crossref","first-page":"P66","DOI":"10.1016\/j.ophtha.2019.09.025","article-title":"Diabetic Retinopathy Preferred Practice Pattern(R)","volume":"127","author":"CJ Flaxel","year":"2020","journal-title":"Ophthalmology"},{"issue":"5","key":"pone.0305586.ref008","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1001\/jamainternmed.2017.0204","article-title":"Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services","volume":"177","author":"LP Daskivich","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"7","key":"pone.0305586.ref009","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1001\/jamaophthalmol.2017.1150","article-title":"Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network","volume":"135","author":"PD Jani","year":"2017","journal-title":"JAMA Ophthalmol"},{"issue":"8","key":"pone.0305586.ref010","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.ophtha.2006.04.018","article-title":"Noncompliance with vision care guidelines in Latinos with type 2 diabetes mellitus: the Los Angeles Latino Eye Study","volume":"113","author":"Los Angeles Latino Eye Study G","year":"2006","journal-title":"Ophthalmology"},{"key":"pone.0305586.ref011","first-page":"41","article-title":"TeleOphthalmology-ready for prime time","author":"J. 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Poverty Datasets Washington D.C.: U.S. Census Bureau; 2021 [updated Nov 22, 2021; cited 2021 Nov 25, 2021https:\/\/www.census.gov\/topics\/income-poverty\/poverty\/data\/datasets.html."},{"issue":"9","key":"pone.0305586.ref037","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/S0161-6420(03)00475-5","article-title":"Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales","volume":"110","author":"CP Wilkinson","year":"2003","journal-title":"Ophthalmology"},{"issue":"2","key":"pone.0305586.ref038","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S0002-9394(98)00309-2","article-title":"Causes of severe visual loss in the early treatment diabetic retinopathy study: ETDRS report no. 24. 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