Development of a store-and-forward telescreening system of diabetic retinopathy: lessons learned from Iran.

Background: The present study describes the development and identity phases of a teleophthalmology system used for screening of diabetic retinopathy.

Methods: A questionnaire was used to identify the main factors necessary for diagnosis of diabetic retinopathy and the features required for a teleophthalmology system. In the second phase, a web-based prototype of the system was designed using the data collected in the previous phase. In the final phase, the system was optimized based on the users' ideas and comments; then, it was evaluated through a standard usability testing questionnaire.

Results: The results showed that the lowest average percentages were related to ethnicity (61%), optometrist's office address (61%), and consultant physician's office address (65%). A web-based prototype was designed using the Visual Studio and Dreamweaver programming tools. This system comprised patient identity data, medical history, clinical data, and retinal images of the patient. The mean score of usability testing and user satisfaction including specialists, residents, and optometrist was 7.3, 7.1 and 7.3 (out of a total 9), respectively. The evaluation results revealed that the system was classified as good.

Conclusion: The telescreening system suggested in the current study could be helpful in timely diagnosis. Moreover, it would reduce the treatment costs and complexities. Regardless of the positive points of telemedicine systems, one of the most challenges in this study was the Internet infrastructure to design and apply the system. The future studies, therefore, could focus on the application of cell phone technology for rendering teleophthalmology.