Patient perceived value of teleophthalmology in an urban, low income US population with diabetes

Dilated eye exams are the standard of care to detect advancing, vision threatening, but often asymptomatic retinopathy in a timely fashion, allowing for vision preserving treatments. Annual exam rates are suboptimal, especially in underserved populations. Although teleophthalmology programs tremendously improve annual exam rates in low income/under resourced settings, widespread adoption is limited. Using a mixed methods approach, three focus groups and individual interviews were conducted for patients with type 2 diabetes (N = 23) who had a teleophthalmology exam or a dilated eye exam. A survey and discussion assessed patients’ perspectives and value of teleophthalmology, including willingness to pay (WTP). Financial, transportation, and motivational barriers to obtaining an annual dilated eye exam were identified. Patients greatly valued having primary care (PC) based teleophthalmology for its convenience and ability to detect disease to allow for timely treatment and would recommend such a service. Although their WTP was at least the amount of their usual copay, cost was universally cited as a concern. Having a conveniently offered PC based teleophthalmology exam was valued. Educating patients on the value and costs of having such exams may be helpful to encourage informed discussions on eye care, especially in low income, underserved populations. Our study is among the few to provide insight on the value and perceptions of teleophthalmology in US low income, urban minority populations needed to help increase uptake of this innovation. Using surveys followed by facilitated discussion allowed for richer and more varied responses.