Expansion in Teleophthalmology Use for Diabetic Retinopathy Screening During the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, the University of California, Davis Health (UCDH) system expanded teleophthalmology for diabetic retinopathy (DR) screening through increased sites and personnel, custom workflows, and improved awareness. Here, we report the outcomes of the expansion and investigate disparities during the pandemic lockdown. Methods: We retrospectively reviewed patients who received remote DR screening to compare demographic, socioeconomic, and clinical differences between individuals who underwent screening before, during, and after the COVID-19 lockdown. Results: UCDH increased quarterly teleophthalmology visits from 46.4 ± 13.9 before to 253.8 ± 38.0 visits after the COVID-19 lockdown (p < 0.001), while DR screening rates improved from 51.0 ± 1.5% to 56.9 ± 1.6% over that period (p = 0.03). During the pandemic, we observed greater proportions of unemployed (p < 0.001), higher-income (p < 0.001), geographically nearby (p = 0.001) patients, and fewer individuals with socioeconomic disadvantage as measured by their area deprivation index (p = 0.02). Fewer patients with poorly controlled diabetes (p = 0.014) or hypertension (p = 0.04) also received remote screening during the pandemic, although most of these disparities were no longer detectable after the initial lockdown. Discussion: Teleophthalmology expansion at UCDH during the COVID-19 pandemic led to sustained improvements in DR screening. Although some vulnerable individuals had reduced access to teleophthalmology during the initial lockdown, these disparities were not sustained postpandemic.