Diagnostic Accuracy of Tele-ophthalmology for Diabetic Retinopathy Assessment: A Meta-analysis and Economic Analysis

Tele-ophthalmology is a screening alternative that facilitates compliance to eye care guidelines regardless of geographic constraints, promoting adequate delivery of health services to underserved communities. We conducted a systematic review and meta-analysis to assess the diagnostic performance of tele-ophthalmology (TO) programs for the detection of diabetic retinopathy (DR), and used decision-tree modeling to explore its cost-effectiveness compared to in-person examination in a semi-urban scenario. From the 1,060 articles initially identified, 23 met inclusion criteria for data extraction. The diagnostic performance of TO for the detection of any DR and referable DR met the minimum diagnostic criteria by the Canadian Ophthalmological Society (sensitivity \u3e80%, specificity \u3e90%). Interpretation of clinical significance is limited due to significant heterogeneity. Considering a semi-urban scenario, the incremental cost per additional case of any DR detected after the introduction of pharmacy-based TO was $314.1, being more costly and more effective than in-person examination