Diabetic Retinopathy Screening Using Non-Mydriatic Fundus Camera in Primary Health Care Settings - A Multicenter Study from Saudi Arabia

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2023 Jun 12

PMID 37304902

Authors

Khalid Mohammad Alabdulwahhab

Affiliations

Soon will be listed here.

Abstract

Background: Screening of diabetic retinopathy (DR) using the current digital imaging facilities in a primary health care setting is still in its early stages in Saudi Arabia. This study aims to reduce the risk of vision impairment and blindness among known diabetic people through early identification by general practitioners (GP) in a primary health care setting in Saudi Arabia. The objective of this study was to evaluate the accuracy of diabetic retinopathy (DR) detection by general practitioners (GPs) by comparing the agreement of DR assessment between GPs and ophthalmologists' assessment as a gold standard.

Methods: A hospital-based, six-month cross-sectional study was conducted, and the participants were type 2 diabetic adults from the diabetic registries of seven rural PHCs, in Saudi Arabia. After medical examination, the participants were then evaluated by fundus photography using a non-mydriatic fundus camera without medication for mydriasis. Presence or absence of DR was graded by the trained GPs in the PHCs and then compared with the grading of an ophthalmologist which was taken as a reference or a gold standard.

Results: A total of 899 diabetic patients were included, and the mean age of the patients was 64.89 ± 11.01 years. The evaluation by the GPs had a sensitivity of 80.69 [95% CI 74.8-85.4]; specificity of 92.23 [88.7-96.3]; positive predictive value, 74.1 [70.4-77.0]; negative predictive value, 73.34 [70.6-77.9]; and an accuracy of 84.57 [81.8-89.88]. For the consensus of agreement the adjusted kappa coefficient was from 0.74 to 0.92 for the DR.

Conclusion: This study demonstrates that trained GPs in rural health centers are able to provide reliable detection results of DR from fundus photographs. The study highlights the need for early DR screening programs in the rural areas of Saudi Arabia to facilitate early identification of the condition and to lessen impact of blindness due to diabetes.

Citing Articles

Potency of teleophthalmology as a detection tool for diabetic retinopathy.

Li L, Jin Y, Wang J, Wang S, Yuan F Sci Rep. 2023; 13(1):19620.

PMID: 37949948 PMC: 10638282. DOI: 10.1038/s41598-023-46554-6.

References

Karason K, Vo D, Grauslund J, Rasmussen M . Comparison of different methods of retinal imaging for the screening of diabetic retinopathy: a systematic review. Acta Ophthalmol. 2021; 100(2):127-135. DOI: 10.1111/aos.14767. View

Fuller S, Hu J, Liu J, Gibson E, Gregory M, Kuo J . Five-Year Cost-Effectiveness Modeling of Primary Care-Based, Nonmydriatic Automated Retinal Image Analysis Screening Among Low-Income Patients With Diabetes. J Diabetes Sci Technol. 2020; 16(2):415-427. PMC: 8861785. DOI: 10.1177/1932296820967011. View

Raman R, Dasgupta D, Ramasamy K, George R, Mohan V, Ting D . Using artificial intelligence for diabetic retinopathy screening: Policy implications. Indian J Ophthalmol. 2021; 69(11):2993-2998. PMC: 8725146. DOI: 10.4103/ijo.IJO_1420_21. View

Antonetti D, Silva P, Stitt A . Current understanding of the molecular and cellular pathology of diabetic retinopathy. Nat Rev Endocrinol. 2021; 17(4):195-206. PMC: 9053333. DOI: 10.1038/s41574-020-00451-4. View

Gale M, Scruggs B, Flaxel C . Diabetic eye disease: A review of screening and management recommendations. Clin Exp Ophthalmol. 2021; 49(2):128-145. DOI: 10.1111/ceo.13894. View

Romero P, Sagarra R, Ferrer J, Fernandez-Ballart J, Baget M . The incorporation of family physicians in the assessment of diabetic retinopathy by non-mydriatic fundus camera. Diabetes Res Clin Pract. 2010; 88(2):184-8. DOI: 10.1016/j.diabres.2010.02.001. View

Rajalakshmi R, Prathiba V, Rani P, Mohan V . Various models for diabetic retinopathy screening that can be applied to India. Indian J Ophthalmol. 2021; 69(11):2951-2958. PMC: 8725090. DOI: 10.4103/ijo.IJO_1145_21. View

McKenna M, Chen T, McAneney H, Vazquez Membrillo M, Jin L, Xiao W . Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China. Br J Ophthalmol. 2018; 102(11):1471-1476. DOI: 10.1136/bjophthalmol-2018-312440. View

Sengupta S, Sindal M, Baskaran P, Pan U, Venkatesh R . Sensitivity and Specificity of Smartphone-Based Retinal Imaging for Diabetic Retinopathy: A Comparative Study. Ophthalmol Retina. 2019; 3(2):146-153. DOI: 10.1016/j.oret.2018.09.016. View

10.

Piyasena M, Gudlavalleti V, Gilbert C, Yip J, Peto T, Macleod D . Development and Validation of a Diabetic Retinopathy Screening Modality Using a Hand-Held Nonmydriatic Digital Retinal Camera by Physician Graders at a Tertiary-Level Medical Clinic: Protocol for a Validation Study. JMIR Res Protoc. 2018; 7(12):e10900. PMC: 6305894. DOI: 10.2196/10900. View

11.

Thapa R, Bajimaya S, Pradhan E, Sharma S, Kshetri B, Paudyal G . Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal. Clin Ophthalmol. 2020; 14:2731-2737. PMC: 7518769. DOI: 10.2147/OPTH.S269002. View

12.

Tang F, Luenam P, Ran A, Quadeer A, Raman R, Sen P . Detection of Diabetic Retinopathy from Ultra-Widefield Scanning Laser Ophthalmoscope Images: A Multicenter Deep Learning Analysis. Ophthalmol Retina. 2021; 5(11):1097-1106. DOI: 10.1016/j.oret.2021.01.013. View

13.

Purola P, Ojamo M, Gissler M, Uusitalo H . Changes in Visual Impairment due to Diabetic Retinopathy During 1980-2019 Based on Nationwide Register Data. Diabetes Care. 2022; 45(9):2020-2027. PMC: 9472510. DOI: 10.2337/dc21-2369. View

14.

AlHargan M, AlBaker K, AlFadhel A, Alghamdi M, AlMuammar S, AlDawood H . Awareness, knowledge, and practices related to diabetic retinopathy among diabetic patients in primary healthcare centers at Riyadh, Saudi Arabia. J Family Med Prim Care. 2019; 8(2):373-377. PMC: 6436279. DOI: 10.4103/jfmpc.jfmpc_422_18. View

15.

Jampol L, Glassman A, Sun J . Evaluation and Care of Patients with Diabetic Retinopathy. N Engl J Med. 2020; 382(17):1629-1637. DOI: 10.1056/NEJMra1909637. View

16.

Virk R, Binns A, Chambers R, Anderson J . How is the risk of being diagnosed with referable diabetic retinopathy affected by failure to attend diabetes eye screening appointments?. Eye (Lond). 2020; 35(2):477-483. PMC: 8027199. DOI: 10.1038/s41433-020-0877-1. View

17.

Pearce E, Sivaprasad S . A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models. Clin Ophthalmol. 2020; 14:3285-3296. PMC: 7569040. DOI: 10.2147/OPTH.S267521. View

18.

Vujosevic S, Aldington S, Silva P, Hernandez C, Scanlon P, Peto T . Screening for diabetic retinopathy: new perspectives and challenges. Lancet Diabetes Endocrinol. 2020; 8(4):337-347. DOI: 10.1016/S2213-8587(19)30411-5. View

19.

Fenner B, Wong R, Lam W, Tan G, Cheung G . Advances in Retinal Imaging and Applications in Diabetic Retinopathy Screening: A Review. Ophthalmol Ther. 2018; 7(2):333-346. PMC: 6258577. DOI: 10.1007/s40123-018-0153-7. View

20.

Zafar S, Mahjoub H, Mehta N, Domalpally A, Channa R . Artificial Intelligence Algorithms in Diabetic Retinopathy Screening. Curr Diab Rep. 2022; 22(6):267-274. DOI: 10.1007/s11892-022-01467-y. View