Training of physician graders on diabetic retinopathy screening using hand-held digital retinal imaging in a nonophthalmic setting

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Abstract Introduction: There is no systematic diabetic retinopathy (DR) screening program in Sri Lanka. We aimed to train and assess physician graders as primary graders of DR screening, using hand-held retinal imaging, in a nonophthalmic setting. Materials and Methods: Selected general duty physicians in a tertiary level medical clinic underwent training to capture and grade DR independently, using a hand-held digital retinal camera (Zeiss Visuscout 100-Germany), at an outpatient medical department. Training curriculum was developed to identify the defined levels of DR, applicable to a resource poor nonophthalmic setting. Eight general physicians from a tertiary level medical department in the Western province of Sri Lanka underwent training. Results: All physicians were trained on knowledge and skills component and one-to-one direct observation was done by the study investigators to assess competency. Physicians underwent self-training until they were competent in capturing required retinal fields and grading them. 100% of them acquired skills on pupil dilatation and capturing required fields using the hand-held digital retinal camera. All physician graders underwent an assessment using a set of archived images in identifying DR signs, grading DR, and identifying the level of gradability. We selected the two best physicians (based on agreement levels, Kappa (k) =0.92 and k = 0.80, range k = 0.48–0.92) after the assessment, for a screening intervention validation study described elsewhere. Conclusions: At the medical clinic level, requirement exists for training and developing skills among physicians for DR screening and grading. The physicians can be effectively trained in DR screening using digital retinal imaging despite poor resources availability.