Telemedicine-based diabetic retinopathy screening in patients over 70 Years: a French cohort study within the OPHDIAT network

AIM: To assess the outcomes of teleophthalmology-based diabetic retinopathy (DR) screening in individuals over 70 years within the OPHDIAT network and to compare them with those of patients aged 18-69 years. METHODS: A cohort of 16,459 diabetic patients, without known DR or with mild non-proliferative DR (NPDR), screened in 2024 in 32 OPHDIAT centers, was included and divided into two groups: < 70 years (n = 13,639) and ≥ 70 years (n = 2,820). Two non-mydriatic retinal photographs per eye were analyzed by certified ophthalmologists. RESULTS: Among patients aged ≥70 years, 21.3% (95% CI: 19.8-22.8) had any DR, and 6.1% (95% CI: 5.2-6.9) were referred to an ophthalmologist for moderate NPDR or a more severe form of the disease, including suspected macular edema. These proportions did not significantly differ from those found in patients < 70 years: 21.9% (95% CI: 21.2-22.6) and 6.1% (95% CI:5.6-6.5), respectively. Severe NPDR or proliferative DR were rare in both groups (1.0%, 95% CI: 0.6-1.4% vs. 1.7%, 95% CI: 1.5-1.9%, P < 0.001). The proportion of ungradable images was higher in the group ≥70 year (14.4%, 95% CI:13.1-15.7% vs. 6.1%, 95% CI: 5.7-6.5%, P < 0.001), particularly in phakic eyes, although 80% of patients had interpretable images for both eyes. Pupil dilation significantly improved image quality in this group. Screening also allowed detecting other ocular disorders, including age-related macular degeneration and glaucoma, which were more common in the group ≥ 70 years (2.1%, 95% CI: 1.5-2.6% vs. 0.6%, 95% CI: 0.4-0.7% P < 0.001). CONCLUSION: Teleophthalmology-based DR screening appeared feasible and clinically relevant in patients aged ≥70 years, allowing identifying patients requiring ophthalmologic evaluation, while also detecting other age-related ocular diseases. Pupil dilation is recommended to optimize image quality in this population.