February 28, 2012 (Abu Dhabi, United Arab Emirates) — A telemedicine program in Germany facilitates interaction between internists and ophthalmologists and helps to identify patients at increased risk for cardiovascular events using information from the retina, according to a study presented here at the World Ophthalmology Congress 2012.
"The eye mirrors vascular and neurodegenerative diseases," said study presenter Georg Michelson, MD, from the University of Erlangen in Germany. "In particular, retinal microangiopathy correlates with certain systemic diseases such as arterial hypertension, stroke, and diabetes." For instance, retinal vessel-wall thickness, which is increased in stroke, can be seen using a nonmydriatic fundus camera.
Dr. Michelson described previous research done by his team, which showed that stroke risk increased 6.35-fold when cotton-wool spots were observed, and increased 4.71-fold with microaneurysms; stroke risk was 4.25-fold higher with blot hemorrhages.
These proven associations led Dr. Michelson to develop his TalkingEyes program, consisting of a network of 31 internists in private practice. The physicians use a mobile nonmydriatic fundus camera to take digital photographs of the retina in the office. These retinal images are uploaded to a Web-based patient chart, where they are evaluated by an ophthalmologist, who then adds a report to the patient's e-chart.
"If we can connect ophthalmologists to internists with a telemedicine network, this could improve patient care," Dr. Michelson explained.
In this study, 6999 patients had retinal exams performed in the general practitioner's office. Median patient age was 54 years, median body mass index was 27.6 kg/m², 40% reported a history of arterial hypertension, and 11.1% had type 2 diabetes.
During the examination, physicians took 45° photographs of the retina, obtained blood samples, and measured blood pressure. They then calculated cardiovascular risk using the PROCAM index. An ophthalmologist analyzed the fundus images remotely.
Dr. Michelson reported that 9% of the cohort had relevant morphologic changes in retinal vessels, such as arteriovenous crossings, retinal bleeding, microaneurysms, and microinfarcts.
Using the PROCAM index, only 2% of patients were found to be at high risk for a cardiovascular event. However, in 55 patients (0.8%) where no risk was indicated, "we found relevant retinal microangiopathic changes," he reported.
"We have now performed this in about 60,000 patients, and we believe that identifying these unique risk factors is having an impact on therapy," said Dr. Michelson.
He believes changes are occurring in 2 ways. "First, individuals who were screened gained a greater awareness of their risk factors overall, so they are motivated to go to the doctor more often for observation." Second, physicians are responding to evidence of elevated risk.
"In about 20% of cases, we see that therapeutic decisions are being made based on these findings."
Dr. Michelson has disclosed no relevant financial relationships.
World Ophthalmology Congress (WOC) 2012: Abstract IS-TEL-FR 65. Presented February 17, 2012.
[CLOSE WINDOW]Authors and DisclosuresJournalistNeil CanavanNeil Canavan is a freelancer for Medscape.
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