Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Abstract

Background: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. Introduction: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program. Methods: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (P pos ) or negative agreement (P neg ) were used to assess variability. Results: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any reti-

The Role of Telemedicine, In-Home Testing and Artificial Intelligence to Alleviate an Increasingly Burdened Healthcare System: Diabetic Retinopathy

“…Several DR telescreening models have been implemented. Retinal images are generally acquired by trained primary care physicians, technicians, ophthalmic photographers and nurses [ 7 , 10 , 12 , 13 , 15 , 17 , 18 , 20 , 22 , 23 , 25 – 27 , 27 – 31 , 53 – 60 , 63 – 65 , 68 – 72 , 51 – 53 , 53 , 97 – 101 , 57 , 58 , 58 , 59 , 26 – 30 , 64 , 64 , 65 , 65 , 48 – 55 , 58 – 60 , 63 – 67 , 81 , 82 , 82 , 83 , 79 – 83 ].…”

“…The data collected in medical centers from diabetic patients during camera-based fundus examinations are sent for diabetic retinopathy detection to experts including ophthalmologists or retinal specialists [ 13 , 16 , 18 , 20 , 21 , 23 , 24 , 26 – 29 , 32 , 33 , 35 , 42 – 45 , 47 – 52 , 54 , 56 , 64 , 67 – 75 , 79 , 81 – 83 ], certified technicians and nurses; in more complicated cases, the data are reevaluated by retinal specialists [ 12 , 15 , 20 , 31 , 41 , 44 , 59 , 63 , 66 , 78 , 102 ].…”

“…To reduce problems with under- or over-evaluation, two or more readers can participate in examinations [ 53 , 80 ]. There can also be two or more masked reviewers, who check the same data, and a third reviewer or more for inconsistent decisions [ 18 , 52 , 80 ]. Prior to commencement of work, some readers have completed a special training program or obtained a certificate for retinal evaluation [ 17 , 18 , 48 , 52 ].…”

“…There were also significant problems regarding telemedicine programs associated with a growing demand for trained/certified eye fundus photographers [ 81 ] and image readers [ 18 , 63 ]. As a solution to that problem, training in picture-taking could be offered to nurses and technicians [ 12 , 15 , 18 , 22 , 23 , 27 , 31 – 34 , 38 , 42 – 45 , 47 , 48 , 50 , 52 – 57 , 60 , 63 , 64 , 68 , 70 – 72 , 74 , 79 – 81 , 98 – 100 ]. One promising solution was in-home testing, where patients themselves took pictures of their retinas [ 97 ].…”

Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic

“…As for imaging methods, Silva et al compared DR identification between non-mydriatic ultrawide field (UWF) imaging and non-mydriatic multi-field fundus photography (NMFP) in a large ocular telehealth program and demonstrated significant benefits of the UWF imaging method [ 44 ]. The “reading” of the retinal images can be done by many health professionals like optometrists, general ophthalmologists and retinal specialists without significant variability, but with the training needed to improve consensus on image grading as Liu et al highlighted [ 45 ]. As for the imaging, that can also be done by nonphysicians [ 46 ].…”