BlueCross BlueShield of Tennessee Medical Policy Manual

Retinal Telescreening for Diabetic Retinopathy


Retinopathy screening and risk assessment with digital imaging systems are proposed as an alternative to conventional dilated fundus examination in diabetic individuals. Digital imaging systems utilize a digital fundus camera to acquire a series of standard field color images and/or monochromatic images of the retina of each eye. The digital images that are captured may then be evaluated on site or transmitted via the Internet to a remote center for interpretation by trained readers, storage and subsequent comparison. This technology has made possible the linking of diabetic individuals in remote locations (where screening might otherwise not be available) with specialty centers that determine if retinopathy is present and recommend treatment if needed.

There are currently several digital camera and transmission systems available, examples include:

The 2016 diabetic retinopathy screening recommendations of the American Diabetes Association

Diabetes Type

Recommended Time of First Exam

Follow-up Exam

Adult - Type 1

Within 5 years of diagnosis


Adult -  Type 2

At time of diagnosis


Considering pregnancy (not gestational diabetes)

Before pregnancy or early in the first trimester of pregnancy

Every trimester during pregnancy and 1 year postpartum

*Less frequent exams (every 2 years) may be considered following one or more normal annual eye exams




Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve the individual’s health status. Telemedicine is sometimes associated with direct clinical services and telehealth with a broader definition of remote healthcare services. Digital imaging systems may be used in the primary care physicians' office. Services that involve the electronic transmission of digital images across the Tennessee State line must adhere to all applicable Tennessee State requirements for the practice of medicine.

Both the American College of Radiology and the American Medical Association recommend that physicians using Teleradiology/ tele-imaging should be licensed in both the state where the images were generated and the state where the images are interpreted. Equipment specifications should assure the same image quality and availability if used for the initial diagnostic image interpretation, or for a review. Transmission and storage of images should adhere to appropriate privacy guidelines and restrictions.


American Academy of Ophthalmology. (2017, December). Diabetic retinopathy. Retrieved December 20, 2017 from

American Diabetes Association. (2018). Standards of medical care in diabetes-2018. Retrieved December 20, 2017 from

American Telemedicine Association. (2011, February). Telehealth practice recommendations for diabetic retinopathy, second edition. Retrieved December 20, 2017 from

BlueCross BlueShield Association. Evidence Positioning System. (3:2018). Retinal telescreening for diabetic retinopathy (9.03.13). Retrieved October 25, 2018 from (35 articles and/or guidelines reviewed) Center for Medicare & Medicaid Services. Palmetto, GBA. (2018, March) Ophthalmology: Extended Ophthalmoscopy and Fundus Photography (LCD ID L33467). Retrieved October 25, 2018 from

Mansberger, S.L., Sheppler, C., Barker, G., Gardiner, S.K., Demirel, S., Wooten, K., & Becker, T.M. (2015). Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: a randomized clinical trial. JAMA Opthalmology, 133 (5), 518-525. Abstract retrieved December 20, 2017 from PubMed database. 

Micheletti, J. M., Hendrick, A. M., Khan, F. N., Ziemer, D. C., & Pasquel, F. J. (2016). Current and next generation portable screening devices for diabetic retinopathy. Journal of Diabetes Science and Technology, 10 (2), 295-300. Abstract retrieved March 9, 2016 from PubMed database.

Shi, L., Wu, H., Dong, J., Jiang, K., Lu, X., & Shie, J. (2015). Telemedicine for detecting diabetic retinopathy: a systematic review and meta-analysis. British Journal of Ophthalmology, 99, 823-831. (Level 1 evidence)

Sreelatha, O. K. & Ramesh, S. V. (2016). Teleophthalmology: improving patient outcomes? Clinical Ophthalmology, 2016, (10), 285-295. (Level 2 evidence)

U.S. Food and Drug Administration.  (May, 1999). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K990205. Retrieved June 5, 2013 from 

Villa, R. S., Alvarez, A. C., Del Valle, de D. R., Mendez, S. R., Garcia, C. M., Garcia, R. M., et al. (2016). Five-year experience of teleophthalmology for diabetic retinopathy screening in a rural population. Archivos de la Sociedad Española de Oftalmología, [Epub ahead of print]. Abstract retrieved March 9, 2016 from PubMed database.




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