Tele-Retinopathy Screening Quality Improvement Project

Background

Diabetic retinopathy is a leading cause of preventable vision loss among adults with diabetes. Although routine retinal screening is recommended, many patients do not receive timely evaluation, increasing the risk of delayed diagnosis and vision-threatening complications. Tele-retinal imaging can improve access to diabetic eye screening within primary care by reducing barriers associated with traditional ophthalmology referrals. This quality improvement project aimed to improve diabetic retinopathy screening while evaluating workflow effectiveness, image quality, and opportunities for process improvement.

Methods

A quality improvement initiative using a Plan-Do-Study-Act (PDSA) framework was implemented in a community-based primary care setting. Patients with diabetes who were due for diabetic retinopathy screening were identified and offered point-of-care tele-retinal imaging. Staff received training on use of the retinal imaging equipment. Following a provider order, trained staff obtained retinal images, which were securely uploaded for remote review by an optometrist. Reports were returned to the primary care provider for review and appropriate follow-up. Screening volume, retinal findings, and image quality were monitored during the initial implementation cycle.

Results

During the first PDSA cycle, 72 patients completed tele-retinal screening. Among screened patients, 21% were identified as having diabetic retinopathy, 53% had no evidence of retinopathy, and approximately 26% had poor-quality or otherwise inadequate images. Screening volume initially increased after implementation but subsequently declined. The proportion of poor-quality images increased over time. Operational challenges included variability in image acquisition technique, delays in image interpretation and processing, and staff preference for structured screening sessions rather than screening exclusively during routine clinical encounters.

Discussion & Conclusion

Tele-retinal screening in a community primary care setting provided diabetic eye screening to patients due for evaluation and identified patients with diabetic retinopathy. However, inadequate images and declining screening volume highlighted limitations in workflow sustainability and staff proficiency with image acquisition. Additional equipment training, standardized imaging protocols, and dedicated screening sessions may improve image quality and screening consistency. Streamlining image interpretation and report turnaround may further strengthen the process. Continued PDSA cycles are needed to address technical and workflow barriers and support sustainable integration of tele-retinal screening into primary care.