Aim: To describe barriers to implementation of diabetic retinopathy (DR) teleretinal screening programs and artificial intelligence (AI) integration at the University of California (UC).
Methods: Institutional representatives from UC Los Angeles, San Diego, San Francisco, Irvine, and Davis were surveyed for the year of their program's initiation, active status at the time of survey (December 2021), number of primary care clinics involved, screening image quality, types of eye providers, image interpretation turnaround time, and billing codes used. Representatives were asked to rate perceptions toward barriers to teleretinal DR screening and AI implementation using a 5-point Likert scale.
Results: Four UC campuses had active DR teleretinal screening programs at the time of survey and screened between 246 and 2,123 patients at 1–6 clinics per campus. Sites reported variation between poor-quality photos (<5% to 15%) and average image interpretation time (1–5 days). Patient education, resource availability, and infrastructural support were identified as barriers to DR teleretinal screening. Cost and integration into existing technology infrastructures were identified as barriers to AI integration in DR screening.
Conclusions: Despite the potential to increase access to care, there remain several barriers to widespread implementation of DR teleretinal screening. More research is needed to develop best practices to overcome these barriers.

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Information & Authors


Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 29Issue Number 12December 2023
Pages: 1810 - 1818
PubMed: 37256712


Published online: 8 December 2023
Published in print: December 2023
Published ahead of print: 30 May 2023
Accepted: 19 December 2022
Revision received: 17 December 2022
Received: 17 November 2022


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    Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
    Mark C. Lin, MD
    Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
    Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, California, USA.
    Christine Thorne, MD
    Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.
    Kristen Kulasa, MD
    Department of Endocrinology, University of California San Diego, La Jolla, California, USA.
    Jay Stewart, MD
    Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA.
    Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
    Eric Nudleman, MD, PhD
    Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
    Matthew Freeby, MD
    Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.
    Maria A. Han, MD, MS, MBA
    Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.
    Sally L. Baxter, MD, MSc [email protected]
    Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
    Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA.


    Address correspondence to: Sally L. Baxter, MD, MSc, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive, MC0946, La Jolla, CA 92093, USA [email protected]

    Disclosure Statement

    S.L.B. has none specifically related to this study; other financial disclosures: equipment from Optomed and consulting fees from voxelcloud.io. G.Y. is consultant for Abbvie, Adverum, Alimera, Anlong, Bausch & Lomb, Cholgene, Clearside, Endogena, Genentech, Gyroscope, Intergalactic, Iridex, NGM Bio, Regeneron, Thea, Topcon, and Zeiss. J.S. has none related to this study; other: Merck. M.A.H. has none. M.F. received research grant Novo Nordisk.

    Funding Information

    Sally Baxter is supported by NIH Grant DP5OD29610 (Bethesda, MD, USA) and an unrestricted departmental grant from Research to Prevent Blindness (New York, NY, USA). Glenn Yiu is supported by NIH Grants R01 EY032238, R34 EY031719, and BrightFocus Foundation. M.F. is supported by NIH Grants NIH 1R56DE030469-01, 1RO1NR017190-01A1, and 1RO1DK116719-01A1.

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