Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy

Prasad, Somdutt; Kamath, Girish G; Jones, Kenneth M.; Clearkin, L G; Phillips, Russell

doi:10.1038/eye.2001.192

Cited by 32 publications

(25 citation statements)

References 36 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: 68%

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: 68%

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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“…[7][8][9][10] The overall prevalence of diabetic retinopathy in the two screened models varied from 21 to 24%. The prevalence in other studies from the UK has been reported as 30.3% in Exeter 11 (EDRS), 40.4% in the Liverpool Diabetic Eye Study 12 (LDES), 41% in insulin-requiring subjects, 13 and 50% in noninsulinrequiring diabetics 14 in the Melton Mowbray Study (MMS).…”

Section: Discussionmentioning

confidence: 99%

“…The sensitivity of 75% and specificity of 98% are similar to other optometry programmes. 8,18 The use of slit-lamp biomicroscopy resulted in better sensitivity than the 65% reported using direct ophthalmoscopy. 7 We agree with nsc that there is a lack of a hard record for quality assurance and/or for monitoring progressive change.…”

Section: Eyementioning

confidence: 99%

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Comparison of optometry vs digital photography screening for diabetic retinopathy in a single district

Palimar

Sen

et al. 2004

Eye

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Purpose To compare (a) the clinical effectiveness and (b) cost effectiveness of the two models in screening for diabetic retinopathy. Methods (a) Retrospective analysis of referral diagnoses of each screening model in their first respective years of operation and an audit of screen positive patients and a sample of screen negatives referred to the hospital eye service from both screening programmes. (b) Cost effectiveness study. Participants (1) A total of 1643 patients screened in the community and in digital photography clinics; (2) 109 consecutive patients referred to the Diabetic Eye Clinic through the two existing models of diabetic retinopathy screening; (3) 55 screen negative patients from the optometry model; (4) 68 screen negative patients audited from the digital photography model. Results The compliance rate was 45% for optometry (O) vs 50% for the digital imaging system (I). Background retinopathy was recorded at screening in 22% (O) vs 17% (I) (P ¼ 0.03) and maculopathy in 3.8% (O) vs 1.7% (I) (P ¼ 0.02). Hospital referral rates were 3.8% (O) vs 4.2% (I) Sensitivity (75% for optometry, 80% for digital photography) and specificity (98% for optometry and digital photography) were similar in both models. The cost of screening each patient was d23.99 (O) vs d29.29 (I). The cost effectiveness was d832 (O) vs d853(I) in the first year. Conclusion The imaging system was not always able to detect early retinopathy and maculopathy; it was equally specific in identifying sight-threatening disease. Cost effectiveness was poor in both models, in their first operational year largely as a result of poor compliance rates in the newly introduced screening programme. Cost effectiveness of the imaging model should further improve with falling costs of imaging systems. Until then, it is essential to continue any existing well-coordinated optometry model.

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“…Esto podría provocar una tremenda sobrecarga asistencial en las unidades especializadas en diabetes ocular, lo que implicaría la existencia de pacientes con formas graves en lista de espera. La manera más eficaz de realizar el cribado de la RD es obtener imágenes de la retina para su clasificación, por lo que hay muchos estudios que tratan de validar esta técnica, comparándola con la biomicroscopía hecha por oftalmólogos (10)(11)(12)(13)(14)(15)(16)(17), o por ópticos (18).…”

Section: Introductionunclassified

Variabilidad inerobservador en el diagnóstico y clasificación de la retinopatía diabética mediante biomicroscopía

Molina-Fernández

Valero-Moll

Pedregal-González

et al. 2008

Arch Soc Esp Oftalmol

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Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy

Cited by 32 publications

References 36 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

Comparison of optometry vs digital photography screening for diabetic retinopathy in a single district

Variabilidad inerobservador en el diagnóstico y clasificación de la retinopatía diabética mediante biomicroscopía

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