Abstract
BackgroundWith the high prevalence of diabetic retinopathy and its significant visual consequences if untreated, timely identification and management of diabetic retinopathy is essential. Teleophthalmology programs have assisted in screening a large number of individuals at risk for vision loss from diabetic retinopathy. Training nonophthalmological readers to assess remote fundus images for diabetic retinopathy may further improve the efficiency of such programs.ObjectiveThis study aimed to evaluate the performance, safety implications, and progress of 2 ophthalmology nurses trained to read and assess diabetic retinopathy fundus images within a hospital diabetic retinopathy telescreening program.MethodsIn this retrospective interobserver study, 2 ophthalmology nurses followed a specific training program within a hospital diabetic retinopathy telescreening program and were trained to assess diabetic retinopathy images at 2 levels of intervention: detection of diabetic retinopathy (level 1) and identification of referable disease (level 2). The reliability of the assessment by level 1−trained readers in 266 patients and of the identification of patients at risk of vision loss from diabetic retinopathy by level 2−trained readers in 559 more patients were measured. The learning curve, sensitivity, and specificity of the readings were evaluated using a group consensus gold standard.ResultsAn almost perfect agreement was measured in identifying the presence of diabetic retinopathy in both level 1 readers (κ=0.86 and 0.80) and in identifying referable diabetic retinopathy by level 2 readers (κ=0.80 and 0.83). At least substantial agreement was measured in the level 2 readers for macular edema (κ=0.79 and 0.88) for all eyes. Good screening threshold sensitivities and specificities were obtained for all level readers, with sensitivities of 90.6% and 96.9% and specificities of 95.1% and 85.1% for level 1 readers (readers A and B) and with sensitivities of 86.8% and 91.2% and specificities of 91.7% and 97.0% for level 2 readers (readers A and B). This performance was achieved immediately after training and remained stable throughout the study.ConclusionsNotwithstanding the small number of trained readers, this study validates the screening performance of level 1 and level 2 diabetic retinopathy readers within this training program, emphasizing practical experience, and allows the establishment of an ongoing assessment clinic. This highlights the importance of supervised, hands-on experience and may help set parameters to further calibrate the training of diabetic retinopathy readers for safe screening programs.
Highlights
IntroductionDiabetic Retinopathy and Remote ScreeningDiabetic retinopathy is the main cause of legal and functional blindness in the working-age population and in many developed countries [1,2]
Diabetic Retinopathy and Remote ScreeningDiabetic retinopathy is the main cause of legal and functional blindness in the working-age population and in many developed countries [1,2]
The prevalence and distribution of disease severity and number of ungradable images were comparable between level 1 and level 2 cohorts and between reader A and B according to the consensus gold standard grading (Multimedia Appendix 2). They were comparable for diabetic retinopathy severity, diabetic macular edema (DME), and ungradable imaging in each individual level reader (Multimedia Appendices 3-5)
Summary
Diabetic Retinopathy and Remote ScreeningDiabetic retinopathy is the main cause of legal and functional blindness in the working-age population and in many developed countries [1,2]. Identification of individuals with diabetes who are at risk [3] and early management of diabetic retinopathy significantly reduces the progression to blindness [4]. In an attempt to improve resource management and relieve the reading interpretation burden on ophthalmologists, various diabetic retinopathy screening programs have introduced nonphysician trained graders to identify patients at risk of vision loss from diabetic retinopathy [23,24,25,26,27,28,29]. Teleophthalmology programs have assisted in screening a large number of individuals at risk for vision loss from diabetic retinopathy. Training nonophthalmological readers to assess remote fundus images for diabetic retinopathy may further improve the efficiency of such programs
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
