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

Abstract

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 web-based 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.