Eye and Systemic Disease Management Changes After Teleophthalmology Screening in Primary Care: Retrospective Cross-Sectional Pilot Study of 200 Consecutive Patients

Background: Undiagnosed ocular diseases and ocular complications from systemic diseases are common in primary care populations, and many can be detected through retinal imaging before symptoms develop. Asynchronous store-and-forward teleophthalmology offers a scalable way to integrate eye screening into primary care, yet its broader impact beyond diabetes and diabetic retinopathy detection remains underexplored. Objective: This study evaluated the outcomes of asynchronous store-and-forward teleophthalmology screening in a primary care clinic, including detection and triage of ocular conditions and subsequent changes in eye and systemic management. Methods: This was a retrospective cross-sectional analysis of the first 200 patients screened in a single primary care clinic in Elmhurst, New York, between January and May 2025. Each patient underwent nonmydriatic external and posterior eye imaging, which was reviewed by a remote reading eye clinician. Reports included eye findings, triage decisions (routine monitoring vs in-person referral), and management recommendations. Subsequent changes in care were extracted from primary care and in-person specialist consult notes. Results: Of 200 patients (mean age 62.1, SD 19.0, range 11‐100 years), 71.5% (143/200, 95% CI 64.9-77.3) had positive eye findings, and 40% (80/200, 95% CI 33.5‐46.9) were referred for in-person eye examinations. Only 8.8% (7/80, 95% CI 4.3-17.0) of referrals were for diabetic retinopathy; most were for glaucoma suspects, age-related macular degeneration, cataracts, and other eye diseases. Image quality was high, with 98.2% (390/397, 95% CI 96.4-99.1) of fundus images being at least partially adequate. Of the 32 patients with documented in-person eye follow-up, 87.5% (28/32) of evaluations confirmed the screening findings. Eye management changes were initiated in 11 patients, whereas systemic management changes occurred in 70 patients, including new prescriptions for Age-Related Eye Disease Study 2 supplements, antihypertensives, diabetes medications, and lipid-lowering agents. Conclusions: Asynchronous teleophthalmology screening in a primary care setting effectively identified both ocular diseases and ocular complications from systemic diseases, leading to meaningful changes in eye and systemic management. The low rate of diabetic retinopathy among referrals highlights the broader diagnostic value of retinal imaging beyond diabetes management. This care model offers a scalable, high-yield strategy for proactive disease detection and interdisciplinary intervention at the primary care level.