Hyungjin Myra Kim1, Julie C Lowery, Ronald Kurtz. 1. Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA.
Abstract
BACKGROUND: To determine the accuracy of diabetic retinopathy status assessments with and without pupil dilation using digital fundus photographs acquired by a clinic staff person and interpreted remotely by ophthalmologists. METHOD: Using early treatment diabetic retinopathy study (EDTRS) grading criteria, diabetic retinopathy status assessments were made by an experienced (nonphysician) retinal grader (NPG) based on seven standard field 35-mm stereoscopic slides acquired by an experienced ophthalmic photographer. These assessments were compared with those of the same eyes made by two ophthalmologists and the NPG using digital photographs acquired by a clinic staff person using a high-resolution (800 x 600) digital color camera system. RESULTS: Based on 35-mm slides, 38% of 244 diabetic patients had ETDRS > or =35 in at least one eye and 5% had vision-threatening diabetic retinopathy (ETDRS > or =53 or macular edema). The proportion of ungradable images was significantly greater for nonmydriatic than mydriatic assessments (30% versus 10% ungradable as determined by the NPG). For ETDRS level > or =35, specificity ranged from moderate to high (0.70 to 0.96) for the three graders, while sensitivity was poor to moderate (0.38 to 0.71), and the area under the receiver-operating characteristic curves was less than satisfactory (0.67 to 0.71). CONCLUSIONS: The low sensitivity of the digital assessments indicates a significant proportion of patients in need of referral would not have been referred. These findings suggest that implementation of a simplified screening system using nonphotographer clinic staff acquiring nonmydriatic images, with interpretation by an ophthalmologist, should take place with an understanding of potential limitations.
BACKGROUND: To determine the accuracy of diabetic retinopathy status assessments with and without pupil dilation using digital fundus photographs acquired by a clinic staff person and interpreted remotely by ophthalmologists. METHOD: Using early treatment diabetic retinopathy study (EDTRS) grading criteria, diabetic retinopathy status assessments were made by an experienced (nonphysician) retinal grader (NPG) based on seven standard field 35-mm stereoscopic slides acquired by an experienced ophthalmic photographer. These assessments were compared with those of the same eyes made by two ophthalmologists and the NPG using digital photographs acquired by a clinic staff person using a high-resolution (800 x 600) digital color camera system. RESULTS: Based on 35-mm slides, 38% of 244 diabeticpatients had ETDRS > or =35 in at least one eye and 5% had vision-threatening diabetic retinopathy (ETDRS > or =53 or macular edema). The proportion of ungradable images was significantly greater for nonmydriatic than mydriatic assessments (30% versus 10% ungradable as determined by the NPG). For ETDRS level > or =35, specificity ranged from moderate to high (0.70 to 0.96) for the three graders, while sensitivity was poor to moderate (0.38 to 0.71), and the area under the receiver-operating characteristic curves was less than satisfactory (0.67 to 0.71). CONCLUSIONS: The low sensitivity of the digital assessments indicates a significant proportion of patients in need of referral would not have been referred. These findings suggest that implementation of a simplified screening system using nonphotographer clinic staff acquiring nonmydriatic images, with interpretation by an ophthalmologist, should take place with an understanding of potential limitations.
Entities:
Keywords:
diabetic retinopathy; screening; sensitivity and specificity; telemedicine
Authors: Eli Ipp; David Liljenquist; Bruce Bode; Viral N Shah; Steven Silverstein; Carl D Regillo; Jennifer I Lim; SriniVas Sadda; Amitha Domalpally; Gerry Gray; Malavika Bhaskaranand; Chaithanya Ramachandra; Kaushal Solanki Journal: JAMA Netw Open Date: 2021-11-01