scholarly journals Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study (Preprint)

2020 ◽  
Author(s):  
Tahmina Begum ◽  
Aminur Rahman ◽  
Dilruba Nomani ◽  
Abdullah Mamun ◽  
Alayne Adams ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Diagnostic Accuracy ◽  
Validation Study ◽  
Gold Standard ◽  
Health Facilities ◽  
Receiver Operating Curve ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

BACKGROUND Diabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden. OBJECTIVE The aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy. METHODS This validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression. RESULTS In 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (<i>P</i>&lt;.001); the odds of having retinopathy in patients with diabetes for 5-10 years (odds ratio [OR] 1.81, 95% CI 1.37-2.41) and more than 10 years (OR 3.88, 95% CI 2.91-5.15) were greater than that in patients with diabetes for less than 5 years. Obesity was found to have a negative association (<i>P</i>=.04) with diabetic retinopathy. CONCLUSIONS Digital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation. CLINICALTRIAL Not applicable

scholarly journals Saving sight in China and beyond: the Lifeline Express model

2018 ◽  
Vol 3 (4) ◽  
pp. e000766 ◽  
Author(s):  
Ian Yat Hin Wong ◽  
Michael Yuxuan Ni ◽  
Irene Oi Ling Wong ◽  
Nellie Fong ◽  
Gabriel M Leung
Keyword(s):  
Diabetic Retinopathy ◽  
Cataract Surgery ◽  
Large Scale ◽  
Rural China ◽  
Adult Population ◽  
Early Screening ◽  
Diabetic Retinopathy Screening ◽  
Health Strategy ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Cataract and diabetic retinopathy are leading causes of blindness globally. Lifeline Express (LEX) has pioneered the provision of cataract surgery in rural China from custom-built trains and eye centres nationwide. Over the past two decades, LEX has provided free cataract surgery for over 180 000 patients in China. In China, half of the adult population has prediabetes and 113 million adults have diabetes. Recognising the rising threat of diabetic retinopathy, LEX has expanded to providing free diabetic retinopathy screening nationwide by establishing 29 Diabetic Retinopathy Screening Centres across China. Source of referrals included host hospitals, the community and out-reach mobile vans equipped with fundus cameras. Fundi photos taken in the mobile vans were electronically transferred to primary graders. LEX also leveraged the widespread smartphone use to provide electronic medical reports via WeChat, the most popular instant messenger app in China. From April 2014 to December 2016, 34 506 patients with diabetes underwent screening, of which 27.2% (9,396) were identified to have diabetic retinopathy. China’s latest national health strategy (‘Healthy China 2030 Plan’) has championed the ‘prevention first’ principle and early screening of chronic diseases. LEX has accordingly evolved to extend its services to save sight in China—from cataract surgery to diabetic retinopathy screening and most recently outreaching beyond its national borders in a pilot South–South collaboration. With health at the top of the China’s developmental agenda and the country’s growing role in global health—LEX’s large-scale telemedicine-enabled programme could represent a potentially scalable model for nationwide diabetic retinopathy screening elsewhere.

Validation of mobile-based funduscope for diabetic retinopathy screening in Estonia

2020 ◽  
pp. 112067212097202
Author(s):  
Birgit Krieger ◽  
Riina Hallik ◽  
Kristina Kala ◽  
Karina Ülper ◽  
Margarita Polonski
Keyword(s):  
Diabetic Retinopathy ◽  
Gold Standard ◽  
Test Accuracy ◽  
Accuracy Measurement ◽  
Diabetic Retinopathy Screening ◽  
Likert Score ◽  
Specificity Study ◽  
The Moment ◽  
Kappa Agreement ◽  
Retinopathy Screening

Aim: To validate mobile-based funduscope for diabetic retinopathy screening in Estonia. Methods: Quality validation comparison of HEINE® iC2 funduscope and Zeiss Visucam camera with image scoring and diagnostic test accuracy measurement by sensitivity and specificity. Study took place from January 2020 until March 2020 in East-Tallinn Central Hospital’s eye clinic. Results: Based on 90 patients, the Zeiss Visucam showed 35.6% DR prevalence while iC2 had 18.9% for images and 17.8% for videos. The average Likert score was 4.7 for Zeiss Visucam and 2.4 for both iC2 images and iC2 videos. The sensitivity of iC2 images was 72.7% (95%CI 49.6–88.4) for grader 1 and 61.9% (95%CI 38.7–81.0) for grader 2, iC2 video sensitivity was 57.1% (95%CI 37.4–75.0) and 65.4% (95%CI 44.4–82.1), respectively. The grader-based specificity for iC2 images was 96.7% (95%CI 80.9–99.8) and 93.5% (95%CI 77.2–98.9). iC2 videos had a 100% (95%CI 91.7–1.0; 92.0–1.0) specificity by both graders. Cohen’s kappa agreement was 0.82 and 0.96 for images and videos. Conclusion: Mobile-based funduscope iC2 is not valid for DR screening with non-dilated pupils and thus not suitable for clinics that do not have experienced specialist present. Moreover, the screening specialist needs to be experienced fundus photographer with extra multiple day training for funduscope use. As main resolution, mobile-based funduscope was not validated for DR screening in Estonia based on pre-set study criteria. Additional research and development of funduscope algorithm for image stripping from videos is needed for validation as iC2 benefits do not offset the gold standard at the moment.

scholarly journals Improving Patient Access to Diabetic Retinopathy Screening Through Telemedicine

Iproceedings ◽  
10.2196/15193 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15193
Author(s):  
Tiffany Wandy ◽  
Michael Kiritsy ◽  
Daniel Durand
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Primary Care Practice ◽  
Primary Care Providers ◽  
Care Practice ◽  
Type I ◽  
Screening Measure ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Background The LifeBridge Health (LBH) Accountable Care Organization (ACO) serves approximately 20,000 Medicare beneficiaries, many of whom have type I or type II diabetes. Diabetic retinopathy (DR) screening is extremely important in helping to preserve patient’s eyesight and overall functional status. However, like many other organizations, LBH has struggled with low compliance rates for DR screening. As result, LBH searched for a solution to improve DR screening care and improve ACO quality and financial performance. Objective LifeBridge sought a telemedicine diagnostic solution that was easy for our physicians and clinic teams to use that would enable improved management of patients with diabetes. A pilot was initiated at three large primary care practice locations in the last quarter of 2017. Two of the locations received table top cameras, while the other location received a more mobile, hand held unit. Working with a dedicated LBH IRIS team, the practices created and implemented workflows, documented processes, and instilled best practices. Methods We used a pre-post test design to measure whether implementation of this tool enabled providers to better meet the diabetic retinopathy screening measure. We included the final months of 2017 in the preperiod to account for any operational changes required to implement the new workflow. Manual chart abstraction of patients seen in the previous 4/6 weeks who were eligible to determine the proportion of patients who met the measure. This was done quarterly in every primary care practice throughout the organization. One of the three practice sites was changed halfway through 2018 and switched to another; however, both practices were included in the analysis. We also compared the number of diabetes patients in the populations of each of the four practices. A two sample z test with a P value of .05 was used to test for statistical significance. Results As of April 2019, 810 patients were screened for diabetic retinopathy. Of these, 33.1% (282 patients) were diagnosed with pathology. Approximately 15.6% (n=133) were diagnosed with DR. We also identified 87 patients who are considered “IRIS saves” patients who had pathology identified that was serious enough to put them at imminent risk of losing their sight. For all patients requiring follow up, direct referrals were made to our in-network ophthalmologists at Krieger Eye Institute for treatment that these patients would not have otherwise received. Statistical comparison of DR screening performance of practices pre and post implementation showed mean screening rates of 38.5% and 47.2%, respectively, with P=.01. Conclusions IRIS screenings allowed our primary care providers to provide more comprehensive care to patients with diabetes, eliminating the need for additional office visits. Having IRIS available in the practice was able to demonstrably improve performance in the diabetic retinopathy screening measure. As a result, primary care providerss with IRIS helped facilitate access to care, thus making it easier for patients make better choices related to their health outcomes. We hope to further use the data to study HbA1c control, medication adherence, and cost/utilization in those diagnosed with retinopathy compared to those with a negative screening.

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