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Abstract Background Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment. Methods This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated. Results Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis. Conclusions Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy and other ophthalmic conditions is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

Purpose: To describe a case of concurrent ophthalmomyiasis externa and aural myiasis in a patient presenting with headache, right eye pain and blurred vision in an urban hospital in Philadelphia, PA. Observations: Myiasis is the parasitic infestation of a live mammal with fly larvae that feed and grow on host tissue. Predominantly described in the Middle East, Africa and Asia, it is rarely reported in the United States. We describe a case of concurrent ophthalmomyiasis externa and aural myiasis in a 44-year-old man who presented with headache, right eye pain and blurred vision in an urban hospital in Philadelphia, PA. After complete extraction and examination at bedside and in the operating room, the patient improved without complications after treatment with topical antibiotics and steroids. Conclusions: Although rare in urban settings in the United States, in certain demographic populations, it is important to consider myiasis in the setting of eye and ear pain and to perform a complete eye and ear examination. Keywords: Ophthalmomyiasis externa, Aural myiasis, Urban, North America, United States