Medical and Scientific Support of JVN

Joslin Vision Network^TM Diabetes Eye Care Program (JVN) was founded by world-renowned Joslin Diabetes Center ophthalmologist Lloyd M. Aiello, M.D., and internationally recognized leader in digital healthcare and teleophthalmology Sven-Erik Bursell, Ph.D., as a means to utilize technology and expertise to reach patient populations at risk of losing vision. The accuracy of JVN as a diagnostic tool for diabetic retinopathy has been rigorously described and validated in several scientific peer review journals.

These reports and other publications have provided full evidence of JVN’s clinical effectiveness and its ability to:

• Compare favorably with “Gold Standard” 35 mm stereo slides with dilated pupils (Ophthalmology 2001)
• Compare favorably with clinical exam through dilated pupils by retinal specialist (Retina 2003)
• Provide annual follow-up retina exam with retinal specialist when previously documented no or mild diabetic retinopathy (American Journal of Ophthalmology 2005)
• Enhance an existing eye care professional referral program in increasing the rate of surveillance and treatment of diabetic retinopathy (Diabetes Care 2005)
• Identify nondiabetic eye disease as compared with clinical exam through dilated pupils by retinal specialist (Ophthalmology May 2006)
• Match favorably the sensitivity and specificity of dilated retinal exams for detecting diabetic retinopathy (Diabetes Care, October 2006)

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1. Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study (ETDRS) seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy (DR).

Conclusion: The JVN undilated digital-video imaging system is comparable to dilated ETDRS photography for the determination of ETDRS clinical Level of Diabetic Retinopathy (DR).

Journal: Ophthalmology 2001; 108:572-585.

Lead Authors: Bursell, SE, Aiello, LM

ABSTRACT

2. Systemic Considerations in the Management of Diabetic Retinopathy (DR).

Conclusion: Eye Care must include diligent evaluation and treatment of the concomitant systemic disorders of diabetes mellitus (DM) that influence the onset and progression of DR.

Journal: Am. J. Ophthalmology. 2001; 132(5):760-76

Lead authors: Aiello LP

ABSTRACT

3. Use of Joslin Vision Network digital-video nonmydriatic retinal imaging to assess diabetic retinopathy in a clinical program.

Conclusion: JVN assessment of ETDRS Clinical Level of Diabetic Retinopathy (DR) and of nondiabetic ocular pathology compares favorably to clinical evaluation and treatment recommendations by an Ophthalmologist Retinal Specialist for patients in a Joslin diabetes patient treatment program.

Journal: Retina, 2003; 23: 215-223

Lead Authors: Cavallerano, JD, Aiello, LM

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4. Perspectives on Diabetic Retinopathy .

Conclusion: Vision loss (severe and moderate) from DM is essentially preventable with timely detection and eye treatments, careful follow-up and comprehensive DM care, all of which are clinical trial evidence-based.

Journal: American Journal of Ophthalmology, 2003; 136(1)122-135

Lead author: Aiello LM

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5. Addition of primary care based retinal imaging technology to an existing eye care professional referral program increased the rate of surveillance and treatment of diabetic retinopathy.

Conclusion: Implementing the JVN system in remote primary care sites resulted in a significant increase in the rate of DR surveillance and a proportional increase in the rate of early timely Laser Treatment for diabetic retinopathy for a large American Indian population.

Journal: Diabetes Care, 2005; 28:318-322

Lead authors: Wilson C, Horton M, and Aiello LM.

ABSTRACT

6. A telehealth program for diabetic retinopathy in a Veterans Affairs Medical Center—the Joslin Vision Network Eye Health Care Model.

Conclusion: In a non-ophthalmic primary care setting, the JVN identifies the ETDRS clinical Level of Diabetic Retinopathy and nondiabetic ocular conditions, permitting appropriate referrals for timely ophthalmological eye and diabetes medical care.

Journal: Am J Ophthalmology, 2005:139; 597-604.

Lead authors: Cavallerano AA, Aiello LM.

ABSTRACT

7. Nonmydriatic digital retinal imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathy.

Conclusion: JVN digital imaging: 1) closely matched clinical examination for ETDRS Level of DR and DME, 2) would have resulted in no patients receiving less stringent follow-up than the accepted standard of care, 3) was well accepted by patients, and 4) may be a suitable alternative for annual dilated retinal examination for determining clinical ETDRS Level of DR and DME and appropriate follow-up comprehensive ophthalmic examination.

Journal: Am J Ophthalmology, 2005; 140:667-673.

Lead authors: Cavallerano JD, Aiello LP,

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8. A modeled economic analysis of a digital teleophthalmology system as used by three federal healthcare agencies for detecting proliferative diabetic retinopathy.

Conclusion: Based on this economic model, the JVN has a potential to be more effective than clinic based ophthalmoscopy for detecting proliferating diabetic retinopathy (DR), permitting timely laser eye surgery and thus averting cases of severe vision loss, and may do so at lower cost.

Journal: telehealth and e-Health 2005; 11:641-651 (2005 award winning article)

Lead authors: Whited, JD, Bursell SE.

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9. Emerging trends in ocular telehealth: the diabetic retinopathy model….Leaders Perspectives, an editorial.

Conclusion: As ocular telehealth demonstrates sustainability, cost effectiveness and respect for patients’ right to privacy, it is poised to become an integral part of eye health care, as long as the tele-care programs meet or exceed the present and future clinical standards of care and patient and provider expectations are clearly defined.

Journal: Journal of telehealth and Telecare, 2005; 11:163-166.

Lead authors: Cavallerano JD, Aiello LM.

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10. Comparison of Nonmydriatic Digital Retinal Imaging vs. Dilated Ophthalmic Examination for Nondiabetic Eye Disease in Persons with Diabetes.

Conclusion: JVN nonmydriatic imaging demonstrates excellent agreement with dilated ophthalmic examination by MD retinal specialists in the detection of ocular disease other than DR and highlights the extent of non-diabetic ocular findings in patients with diabetes.

Journal: Ophthalmology, 2006; 113:833-840.

Lead authors: Chow S-P, Aiello LM

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11. The Sensitivity and Specificity of Nonmydriatic Digital Stereoscopic Retinal Imaging (NMDSRI) in Detecting Diabetic Retinopathy.

Conclusion: This NMDSRI study using the JVN demonstrated an overall sensitivity of 98% and a specificity of 100% for diabetic retinopathy within one grade of dilated retina examination and 100% agreement with clinical examination in patients with DR and DME.

Journal: Diabetes Care, 2006; 29: 2205-2209

First & senior authors: Ahmed J, Ward T, Vigersky R, Bursell SE

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