Letter to the Editor
Tele-ophthalmology for diabetic retinopathy screening: Value of continuing education
Teleoftalmología para el cribado de la retinopatía diabética: valor de la formación continuada
R. Abreu-González
, M. Alonso-Plasencia
Corresponding author
Servicio de Oftalmología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
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Abreu-González, M. Alonso-Plasencia" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Abreu-González" "email" => array:1 [ 0 => "rodrigoabreug@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Alonso-Plasencia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Teleoftalmología para el cribado de la retinopatía diabética: valor de la formación continuada" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the report by Dr. Pareja-Ríos et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> titled “Tele-ophthalmology for screening of diabetic retinopathy: 8 years experience” analyzing the results obtained by the RETISALUD program of the Health Services of the Canary Islands for screening diabetic retinopathy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to congratulate the authors for the excellent work and for sharing the activities being carried out by said Health Services in cooperation with primary care physicians and ophthalmologists of the region hospitals who have been working for over 8 years to improve diabetic retinopathy screening. In said paper, the authors point out that it would be interesting to carry out protocolized control studies with random reviews of retinographies classified as normal by primary health care physicians in order to assess the degree of sensitivity.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During the 89th Congress of the Ophthalmology Society of Spain held September 2013 in Tenerife, we presented on behalf of the Nuestra Señora de Candelaria University Hospital (HUNSC) a spoken communication titled “Predictive values in the daily practice of diabetic retinopathy screening with ophthalmology software”, authored by Dr. Alonso-Plasencia et al. Said study reviewed a sample of 200 retinographies analyzed by primary health care physicians within the RETISALUD program. These retinographies were randomly selected by the Canary Islands Health Services. The positive predictive value or the probability that a retinography reported as pathological is true was 35.19%, while the negative predictive value or the probability that a retinography reported as healthy is true was of 94.4%. This means that primary health care physicians refer many healthy patients to the ophthalmologist as pathological cases, while when they refer healthy patients the probability of being right is very high. One of the conclusions was that these results could be due to the absence of refresher training for primary health care physicians.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2013, a new training program for primary health care doctors was launched in the framework of the RETISALUD program in 12 of the primary care centers in the HUNSC area. After said training, the results of primary care retinography screenings were reviewed and presented at the meeting of the Association for Research in Vision and Ophthalmology (ARVO), held last June 2016 in Seattle, USA. The results showed statistically significant improvements after said refresher training. True positives increased from 30.5% to 41.4% and false positives diminished from 56.2% to 48.3%.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the risks of failure identified after the deployment of a telemedicine program is sustainability, i.e., it must be based on committed and involved personnel who must be incentivated and motivated to maintain their interest in the project and to reach the objectives set out in the original design.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> We believe that, on the basis of our results, regular reviews of telemedicine program performance and sustained ongoing training are key factors for maintaining and improving the results of participating patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abreu-González R, Alonso-Plasencia M. Teleoftalmología para el cribado de la retinopatía diabética: valor de la formación continuada. Arch Soc Esp Oftalmol. 2017;92:e37–e38.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teleoftalmología para el cribado de la retinopatía diabética: experiencia de 8 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Pareja-Ríos" 1 => "S. Bonaque-González" 2 => "M. Serrano-García" 3 => "F. Cabrera-López" 4 => "P. Abreu-Reyes" 5 => "M.D. Marrero-Saavedra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2016.08.006" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2017" "volumen" => "92" "paginaInicial" => "63" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27756515" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implementation of telemedicine programs in Spain: experience of the main actors involved in the decision-making process" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Mahtani Chugani" 1 => "R.L. Martín Fernández" 2 => "E. Soto Pedre" 3 => "V. Yanes López" 4 => "P. Serrano Aguilar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2008.06.005" "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2009" "volumen" => "23" "paginaInicial" => "223" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19250710" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009200000007/v1_201706250033/S2173579417301251/v1_201706250033/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000007/v1_201706250033/S2173579417301251/v1_201706250033/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301251?idApp=UINPBA00004N" ]
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