A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy

Olson, Jim; Strachan, F.; Hipwell, John H.; Goatman, Keith A; McHardy, K C; Forrester, John V.; Sharp, P.

doi:10.1046/j.1464-5491.2003.00969.x

Cited by 147 publications

(120 citation statements)

References 28 publications

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“…Similar studies in countries like the UK had clinical practice as part of their curriculum. The studies showed sensitivity between 72% and 76% and specificity between 77% and 99% (Hulme et al, 2002;Olson et al, 2003;Prasad et al, 2001). These results were somewhat poorer in sensitivity, but better in specificity than our results.…”

Section: Discussioncontrasting

confidence: 56%

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Screening of Diabetes Retinopathy in Optometry: Assessment of a Web-based Training Protocol

Sundling

Aamodt

2017

Scand J Optom Vis Sci

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Diabetic retinopathy is a sight threatening complication of diabetes mellitus. Regular eye examinations by trained health professionals can help prevent this. Although ophthalmologists have screening responsibility in Norway today, Norwegian optometrists regularly examine the ocular health of a large part of the population. The exact number of people with diabetes in Norway is unknown, and many are likely undiagnosed. Optometrists should be able to detect and grade diabetic retinopathy and ensure proper management of these patients. Previous studies in Norway have shown that optometrists need improved diagnostic skills to provide screening according to recommended standards. This study investigated the effect of web-based targeted training on the optometrists' ability to detect, classify and manage patients with diabetic retinopathy. The study had an experimental prospective design. Eighteen optometrists working in optometric practice in Norway participated in a web-based survey "Visual Identification and Management of Ocular Conditions" (VIMOC) related to diabetic retinopathy before and after a minimal web-based training protocol. In the VIMOC, the optometrists assessed 14 retinal digital photographs of people with known diabetes. An ophthalmologist's assessment and grading of the images was considered as the gold standard. The prevalence of retinopathy in the sample was set to 50% to prevent false high specificity. The webbased training significantly improved the optometrists' diagnostic sensitivity, but did not significantly improve specificity. The diagnostic sensitivity before training was 71.4% (SD = 19.6). After training, the sensitivity was 85.71% (SD = 12.9). However, only six (33%) of the optometrists achieved the recommended screening standard; sensitivity of 80% or better and specificity of 95% of better. Web-based training in screening for diabetic retinopathy significantly improved optometrists' screening and grading skills. Specific training in diabetes and screening for diabetic retinopathy are of great importance for detection and management of patients with diabetes by optometrists. SammendragDiabetes retinopati er en synstruende senkomplikasjon av diabetes mellitus. Regelmessige undersøkelser av øynene hos trent helsepersonell kan forebygge dette. Selv om øyeleger har hovedansvaret for screening i dag undersøker norske optikere regelmessig øyehelsen til en stor del av befolkningen. Det er antakelig store mørketall for hvor mange som har diabetes i Norge. Optikere bør på bakgrunn av dette vaere godt skikket for å oppdage og gradere diabetes retinopati, for videre å sikre korrekt håndtering av pasientene. Tidligere studier i Norge har vist at optikerne i snitt ikke hadde god nok sensitivitet og spesifisitet for diabetes retinopati ved screening, og kunne derfor ikke påta seg et kvalitetssikret screeningansvar. I denne studien har man derfor undersøkt om målrettet web-basert undervisning kan bedre optikeres evne til å oppdage, klassifisere og håndtere pasienter med diabetes retinopati. St...

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Section: Discussioncontrasting

confidence: 56%

“…It has also been shown that assessment of red-free retinal images is better than retinal slit-lamp examination, but the best results were achieved by grading colour images (Olson et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Screening of Diabetes Retinopathy in Optometry: Assessment of a Web-based Training Protocol

Sundling

Aamodt

2017

Scand J Optom Vis Sci

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“…Other assessment systems in published reports have combined field and 14,15 or image definition alone 16 and usually do not address whether the fovea can be visualised as an independent criterion. We demonstrate the most common cause of an ungradeable image was the fovea not being adequately visualised, whether mydriasis was used or not.…”

Section: Discussionmentioning

confidence: 99%

Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy?

Murgatroyd

Cox

Ellingford

et al. 2006

Eye

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Purpose We aimed to determine the reasons for, and variables which predicted, ungradeable retinal photographs during screening patients for diabetic retinopathy. Materials and methods Age, duration of diabetes, visual acuity, and HbA1c were recorded. Following dark adaptation, a single 451 nonmydriatic photograph was taken of each fundus. The pupils were then dilated and the photograph repeated. Using slit lamp biomicroscopy, lenticular changes (LOCS III), and fundus appearance were recorded. Results In ungradeable photographs the fovea could not be visualised in 98% of cases of images from nonmydriatic photography, and in 88% if mydriasis was used. Poor definition in the nonmydriatic image was associated with a subsequent ungradeable mydriatic photograph (P ¼ 0.001), however, the positive predictive value was poor (34%). Age, posterior subcapsular cataract, and near vision predicted ungradeable status of nonmydriatic photographs (Po0.001, P ¼ 0.004, P ¼ 0.006, respectively; regression analysis). Nuclear colour and poor definition of the nonmydriatic photograph predicted ungradeable status of mydriatic photographs (P ¼ 0.006 & P ¼ 0.001, respectively). Conclusion Inability to visualise the fovea is the commonest cause of an ungradeable image from digital retinal photography. Age and posterior subcapsular cataract were best predictors of ungradeable status of nonmydriatic fundus photographs. Nuclear colour was the strongest predictor for ungradeable mydriatic photography.

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“…In the absence of a dilated fundus examination by a trained examiner, use non-mydriatic (or mydriatic) photography with adequate sensitivity, specificity and low technical failure rate to detect presence of DR (Systematic review of diagnostic accuracy studies 20 and individual diagnostic accuracy studies [22][23][24][25][26] ).…”

mentioning

confidence: 99%

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

Foreman

Keel

Xie

et al. 2017

Medical Journal of Australia

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A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy

Cited by 147 publications

References 28 publications

Screening of Diabetes Retinopathy in Optometry: Assessment of a Web-based Training Protocol

Screening of Diabetes Retinopathy in Optometry: Assessment of a Web-based Training Protocol

Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy?

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

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