Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China

McKenna, Martha; Chen, Tingting; McAneney, Helen; Membrillo, Miguel Angel Vazquez; Jin, Ling; Xiao, Wei; He, Mingguang; Hogg, Ruth; Congdon, Nathan

doi:10.1136/bjophthalmol-2018-312440

Cited by 26 publications

(18 citation statements)

References 17 publications

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“…A similar DR grader sensitivity of 92.5% and specificity of 88% was reported by Goatman et al (2012). Interestingly, recent studies by Bhargava et al and McKenna et al showed better diagnostic accuracy in DR grading among non-medical graders compared to that of family physicians or rural doctors (Bhargava et al 2012;McKenna et al 2018). These results are in line with our suggestion to improve DR screening by involving a non-medical photographer reader in the process as the first-line grader.…”

Section: Discussionsupporting

confidence: 55%

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Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study

Kubin

Wirkkala

Keskitalo

et al. 2021

Acta Ophthalmologica

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Purpose: To compare the performance and image quality of the handheld fundus camera to standard table-top fundus cameras in diabetic retinopathy (DR) screening. The reliability and diagnostic accuracy of DR grading performed by an ophthalmologist and a photographer reader were evaluated. Materials and methods: 157 patients with diabetes, attending screening or follow-up of DR, were evaluated by fundus photographs taken in mydriasis by Optomed Aurora and Canon or Zeiss Visucam fundus cameras. The image quality and the severity of DR were evaluated independently by an ophthalmologist and experienced photographer. The sensitivity, specificity and reliability of the assessments were determined. Results: 1884 fundus images from 314 eyes were analysed. In 53% of all eyes, DR was not present. 10% had mild non-proliferative diabetic retinopathy (NPDR), 16% moderate NPDR, 6% severe NPDR and 16% proliferative diabetic retinopathy (PDR). The DR grading outcomes by Aurora highly equalled to those of Canon or Zeiss (j = 0.93, 95% CI 0.91 to 0.94), and there was almost perfect agreement in grading between the ophthalmologist and photographer (j = 0.96, 95% CI 0.95 to 0.97). The image quality of Aurora was sufficient for reliable assessment according to both graders in 84-88% of the cases. Conclusion:The Optomed Aurora fundus camera seems appropriate for DR screening. The sufficient image quality and high diagnostic accuracy for DR grading are supportive for a less expensive and easily transportable screening system for DR. Immediate image grading carried out by a photographer would further improve and speed up the screening process in all settings.

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Section: Discussionsupporting

confidence: 55%

“…2012; McKenna et al. 2018). These results are in line with our suggestion to improve DR screening by involving a non‐medical photographer reader in the process as the first‐line grader.…”

Section: Discussionmentioning

confidence: 99%

Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study

Kubin

Wirkkala

Keskitalo

et al. 2021

Acta Ophthalmologica

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“…By contrast, in the passive case detection cohort, DR was ascertained through fundus examinations performed by trained rural ophthalmologists. Our group previously found that rural ophthalmologists in this region detect proliferative DR with 66% sensitivity and 91% specificity, and macular oedema with 65% sensitivity and 95% specificity [ 26 ]. Applying standard bias analysis methods for differential misclassification of binary outcomes [ 27 ], we estimated that the observed disparity in levels of STDR between outreach screening and passive case detection is likely a conservative estimate of the true disparity ( results not shown).…”

Section: Discussionmentioning

confidence: 99%

Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China

et al. 2022

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Importance Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments. Objectives We examined whether outreach screening in rural China improves equity of access. Design, setting and participants We compared prevalence of female sex, age > = 65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n = 193); persons screened during primary-level DR outreach (n = 182); and individuals with newly- or previously-diagnosed diabetes in a population survey (n = 579). The latter reflected the “ideal” reach of a screening program. Results Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p < 0·001), and less-educated persons (39·9% vs. 89·6%, p < 0·001). Outreach screening, compared to passive case detection, improved representation of the elderly (49·5% vs. 37·8%, p = 0·03) and less-educated (70·3% vs. 39·9%, p<0·001). The proportion of women (59.8% vs 62.3%, P>0.300) and persons aged > = 65 years (49.5% vs 51.3%, p = 0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both). Conclusions and relevance Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital.

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“…There is an extensive body of global evidence which shows that when properly trained, their results are accurate. [ 7 42 43 44 45 46 47 48 49 50 ] Establishing screening pathways is recognized as an essential component for the effectiveness of screening programs. It starts right from identifying the population eligible for screening till treatment, follow-up, and monitoring outcomes.…”

Section: The Way Forward For Systematic Dr Screening In Public Sector...mentioning

confidence: 99%

“…There is an extensive body of global evidence which shows that when properly trained, their results are accurate. [ 7 42 43 44 45 46 47 48 49 50 ]…”

Section: The Way Forward For Systematic Dr Screening In Public Sector...mentioning

confidence: 99%

Diabetic retinopathy screening in the public sector in India: What is needed?

Gupta

Azad

Vashist³

et al. 2022

Indian Journal of Ophthalmology

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India has been witnessing an epidemic of diabetes for several years now. A large proportion of patients with undiagnosed and poorly controlled diabetes are at great risk of developing diabetic retinopathy (DR) and irreversible blindness. The goal of DR screening is to identify people with sight-threatening DR early so that prompt treatment can be initiated, and blindness can be prevented. Systematic DR screening is essential to identify disease early, and a national effort for the same is required. We adopt a health system approach to outline the actions that need to take place for effective DR screening in the public sector in India. We discuss the role of national leadership, needs assessment, finalization of DR screening and referral pathway, trainings, strategies to improve the uptake, allocation of roles and responsibilities, public-private partnerships, quality control, and financing.

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Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China

Cited by 26 publications

References 17 publications

Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study

Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study

Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China

Diabetic retinopathy screening in the public sector in India: What is needed?

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