1
|
Rahmati M, Smith L, Boyer L, Fond G, Yon DK, Lee H, Soysal P, Piyasena MP, Pardhan S. Factors Affecting Global Adherence for the Uptake of Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2024; 268:94-107. [PMID: 39094991 DOI: 10.1016/j.ajo.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes. DESIGN Systematic review and meta-analysis. METHODS This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024, using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding. RESULTS Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR = 1.65, 95% CI 1.45-1.78), marriage (OR = 1.42, 95% CI 1.14-1.77), living in an urban area (OR = 1.57, 95% CI 1.08-2.29), higher family income (OR = 1.29, 95% CI 1.24-1.35), having any health insurance (OR = 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR = 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR = 1.68, 95% CI 1.34-2.10), family history of diabetes (OR = 2.25, 95% CI 1.56-3.25), vision impairment (OR = 2.07, 95% CI 1.43-2.98), history of eye diseases (OR = 1.99, 95% CI 1.36-2.90), insulin treatment (OR = 1.38, 95% CI 1.37-1.39), and good mental health (OR = 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence. CONCLUSION This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening. REGISTRATION INFORMATION PROSPERO; ref. no. CRD42024507035, (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=507035).
Collapse
Affiliation(s)
- Masoud Rahmati
- From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University (M.R.), Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan (M.R.), Rafsanjan, Iran.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University (L.S.), Cambridge, United Kingdom
| | - Laurent Boyer
- From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France
| | - Guillaume Fond
- From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine (D.K.Y., H.L.), Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University College of Medicine (D.K.Y.), Seoul, Republic of Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine (D.K.Y., H.L.), Seoul, Republic of Korea
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University (P.S.), Istanbul, Turkey
| | - Mapa Prabhath Piyasena
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University (M.P.P., S.P.), Cambridge, United Kingdom
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University (M.P.P., S.P.), Cambridge, United Kingdom; Centre for Inclusive Community Eye Health, Anglia Ruskin University (S.P.), Cambridge, United Kingdom.
| |
Collapse
|
2
|
Shrateh O, Abdelhafez M, Ereqat S, Dein L, Iriqat S. Identification of Risk Factors for the Development of Diabetic Retinopathy Among Palestinian Adults With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Endocrinol Diabetes Metab 2024; 7:e494. [PMID: 38874277 PMCID: PMC11177287 DOI: 10.1002/edm2.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Although risk factors linked to diabetic retinopathy (DR) among patients with Type 2 diabetes mellitus (T2DM) have been extensively studied globally, the specific determinants of these factors in relation to DR in Palestine are presently not well understood. METHODS This retrospective cross-sectional study included patients who underwent DR screening with a fundus camera (VersaCam a). The study included patients aged ≥18 with T2DM, excluding those with other types of diabetes or a history of malignancies. Univariable and multivariable logistic regressions were used to identify factors associated with DR. RESULTS A total of 1163 patients with T2DM were included in this study. Of these, 211 (18.1%) patients were classified in the DR group, 761 (65.4%) in the no DR group and 191 (16.4%) were ungradable. Among the included patients, 434 (37.3%) were male. A secondary level of education or higher and a BMI ≥30 kg/m2, compared with <25 kg/m2, were independently and inversely associated with DR, with odds ratios (ORs) of 0.46 (p < 0.001) and 0.58 (p = 0.046), respectively. A 5-year increase in the duration of T2DM correlated with 45% higher odds of having DR (p < 0.001). Patients with DR were more likely to have HbA1c >7%, be physically inactive and use insulin, with ORs of 1.63 (p = 0.02), 2.05 (p < 0.001) and 1.53 (p = 0.03), respectively. Age, gender, occupational status, hypertension and hyperlipidaemia were not independent predictors of DR (p < 0.05). CONCLUSION Longer duration of T2DM, HbA1c >7%, physical inactivity and insulin use were all independently associated with the presence of DR. Furthermore, a secondary or higher educational level and obesity demonstrated independent and inverse associations with the development of DR.
Collapse
Affiliation(s)
| | - Mohammad Abdelhafez
- Department of Internal Medicine, Faculty of MedicineAl‐Quds UniversityJerusalemPalestine
| | - Suheir Ereqat
- Biochemistry and Molecular Biology Department, Faculty of MedicineAl‐Quds UniversityJerusalemPalestine
| | | | - Salam Iriqat
- Ocular Inflammatory Disease DepartmentSt John Eye HospitalJerusalemPalestine
| |
Collapse
|
3
|
Hu G, Gu L, Wang R, Jian Q, Lv K, Xia M, Lai M, Shen T, Hu J, Yang S, Ye C, Zhang X, Wang Y, Xu X, Zhang F. Ethanolamine as a biomarker and biomarker-based therapy for diabetic retinopathy in glucose-well-controlled diabetic patients. Sci Bull (Beijing) 2024; 69:1920-1935. [PMID: 38423871 DOI: 10.1016/j.scib.2023.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/21/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024]
Abstract
Diabetic retinopathy (DR) is the leading cause of blindness among the working-age population. Although controlling blood glucose levels effectively reduces the incidence and development of DR to less than 50%, there are currently no diagnostic biomarkers or effective treatments for DR development in glucose-well-controlled diabetic patients (GW-DR). In this study, we established a prospective GW-DR cohort by strictly adhering to glycemic control guidelines and maintaining regular retinal examinations over a median 2-year follow-up period. The discovery cohort encompassed 71 individuals selected from a pool of 292 recruited diabetic patients at baseline, all of whom consistently maintained hemoglobin A1c (HbA1c) levels below 7% without experiencing hypoglycemia. Within this cohort of 71 individuals, 21 subsequently experienced new-onset GW-DR, resulting in an incidence rate of 29.6%. In the validation cohort, we also observed a significant GW-DR incidence rate of 17.9%. Employing targeted metabolomics, we investigated the metabolic characteristics of serum in GW-DR, revealing a significant association between lower levels of ethanolamine and GW-DR risk. This association was corroborated in the validation cohort, exhibiting superior diagnostic performance in distinguishing GW-DR from diabetes compared to the conventional risk factor HbA1c, with AUCs of 0.954 versus 0.506 and 0.906 versus 0.521 in the discovery and validation cohorts, respectively. Furthermore, in a streptozotocin (STZ)-induced diabetic rat model, ethanolamine attenuated diabetic retinal inflammation, accompanied by suppression of microglial diacylglycerol (DAG)-dependent protein kinase C (PKC) pathway activation. In conclusion, we propose that ethanolamine is a potential biomarker and represents a viable biomarker-based therapeutic option for GW-DR.
Collapse
Affiliation(s)
- Guangyi Hu
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Liping Gu
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ruonan Wang
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Qizhi Jian
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Kangjia Lv
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Mengxue Xia
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Mengyu Lai
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Tingting Shen
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jing Hu
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Sen Yang
- Zhejiang Provincial Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou 310058, China; Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Cunqi Ye
- Zhejiang Provincial Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou 310058, China; Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiaonan Zhang
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
| | - Xun Xu
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China.
| | - Fang Zhang
- National Clinical Research Center for Eye Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; Eye Institute of Shanghai Jiao Tong University School, Shanghai 200080, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China.
| |
Collapse
|
4
|
Xie L. Precision management of diabetes subtyping: A spotlight on glucose-well-controlled patients with diabetic retinopathy onset. Sci Bull (Beijing) 2024; 69:1816-1818. [PMID: 38734584 DOI: 10.1016/j.scib.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Lixin Xie
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 250004, China.
| |
Collapse
|
5
|
Karabeg M, Petrovski G, Hertzberg SN, Erke MG, Fosmark DS, Russell G, Moe MC, Volke V, Raudonis V, Verkauskiene R, Sokolovska J, Haugen IBK, Petrovski BE. A pilot cost-analysis study comparing AI-based EyeArt® and ophthalmologist assessment of diabetic retinopathy in minority women in Oslo, Norway. Int J Retina Vitreous 2024; 10:40. [PMID: 38783384 PMCID: PMC11112837 DOI: 10.1186/s40942-024-00547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of adult blindness in the working age population worldwide, which can be prevented by early detection. Regular eye examinations are recommended and crucial for detecting sight-threatening DR. Use of artificial intelligence (AI) to lessen the burden on the healthcare system is needed. PURPOSE To perform a pilot cost-analysis study for detecting DR in a cohort of minority women with DM in Oslo, Norway, that have the highest prevalence of diabetes mellitus (DM) in the country, using both manual (ophthalmologist) and autonomous (AI) grading. This is the first study in Norway, as far as we know, that uses AI in DR- grading of retinal images. METHODS On Minority Women's Day, November 1, 2017, in Oslo, Norway, 33 patients (66 eyes) over 18 years of age diagnosed with DM (T1D and T2D) were screened. The Eidon - True Color Confocal Scanner (CenterVue, United States) was used for retinal imaging and graded for DR after screening had been completed, by an ophthalmologist and automatically, using EyeArt Automated DR Detection System, version 2.1.0 (EyeArt, EyeNuk, CA, USA). The gradings were based on the International Clinical Diabetic Retinopathy (ICDR) severity scale [1] detecting the presence or absence of referable DR. Cost-minimization analyses were performed for both grading methods. RESULTS 33 women (64 eyes) were eligible for the analysis. A very good inter-rater agreement was found: 0.98 (P < 0.01), between the human and AI-based EyeArt grading system for detecting DR. The prevalence of DR was 18.6% (95% CI: 11.4-25.8%), and the sensitivity and specificity were 100% (95% CI: 100-100% and 95% CI: 100-100%), respectively. The cost difference for AI screening compared to human screening was $143 lower per patient (cost-saving) in favour of AI. CONCLUSION Our results indicate that The EyeArt AI system is both a reliable, cost-saving, and useful tool for DR grading in clinical practice.
Collapse
Affiliation(s)
- Mia Karabeg
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000, Split, Croatia
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000, Bitola, Macedonia
| | - Silvia Nw Hertzberg
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Dag Sigurd Fosmark
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Greg Russell
- Clinical Development, Eyenuk Inc, Woodland Hills, CA, USA
| | - Morten C Moe
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Vallo Volke
- Faculty of Medicine, Tartu University, 50411, Tartu, Estonia
| | - Vidas Raudonis
- Automation Department, Kaunas University of Technology, 51368, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | | | | | - Beata Eva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway.
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.
- Institute of Endocrinology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania.
| |
Collapse
|
6
|
Mellor J, Jiang W, Fleming A, McGurnaghan SJ, Blackbourn LAK, Styles C, Storkey A, McKeigue PM, Colhoun HM. Prediction of retinopathy progression using deep learning on retinal images within the Scottish screening programme. Br J Ophthalmol 2024; 108:833-839. [PMID: 38316534 DOI: 10.1136/bjo-2023-323400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/09/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND/AIMS National guidelines of many countries set screening intervals for diabetic retinopathy (DR) based on grading of the last screening retinal images. We explore the potential of deep learning (DL) on images to predict progression to referable DR beyond DR grading, and the potential impact on assigned screening intervals, within the Scottish screening programme. METHODS We consider 21 346 and 247 233 people with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), respectively, each contributing on average 4.8 and 4.4 screening intervals of which 1339 and 4675 intervals concluded with a referable screening episode. Information extracted from fundus images using DL was used to predict referable status at the end of interval and its predictive value in comparison to screening-assigned DR grade was assessed. RESULTS The DL predictor increased the area under the receiver operating characteristic curve in comparison to a predictor using current DR grades from 0.809 to 0.87 for T1DM and from 0.825 to 0.87 for T2DM. Expected sojourn time-the time from becoming referable to being rescreened-was found to be 3.4 (T1DM) and 2.7 (T2DM) weeks less for a DL-derived policy compared with the current recall policy. CONCLUSIONS We showed that, compared with using the current retinopathy grade, DL of fundus images significantly improves the prediction of incident referable retinopathy before the next screening episode. This can impact screening recall interval policy positively, for example, by reducing the expected time with referable disease for a fixed workload-which we show as an exemplar. Additionally, it could be used to optimise workload for a fixed sojourn time.
Collapse
Affiliation(s)
- Joseph Mellor
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Wenhua Jiang
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Alan Fleming
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Stuart J McGurnaghan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Luke A K Blackbourn
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | | | - Amos Storkey
- School of Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Helen M Colhoun
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Qian B, Chen H, Wang X, Guan Z, Li T, Jin Y, Wu Y, Wen Y, Che H, Kwon G, Kim J, Choi S, Shin S, Krause F, Unterdechler M, Hou J, Feng R, Li Y, El Habib Daho M, Yang D, Wu Q, Zhang P, Yang X, Cai Y, Tan GSW, Cheung CY, Jia W, Li H, Tham YC, Wong TY, Sheng B. DRAC 2022: A public benchmark for diabetic retinopathy analysis on ultra-wide optical coherence tomography angiography images. PATTERNS (NEW YORK, N.Y.) 2024; 5:100929. [PMID: 38487802 PMCID: PMC10935505 DOI: 10.1016/j.patter.2024.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024]
Abstract
We described a challenge named "DRAC - Diabetic Retinopathy Analysis Challenge" in conjunction with the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2022). Within this challenge, we provided the DRAC datset, an ultra-wide optical coherence tomography angiography (UW-OCTA) dataset (1,103 images), addressing three primary clinical tasks: diabetic retinopathy (DR) lesion segmentation, image quality assessment, and DR grading. The scientific community responded positively to the challenge, with 11, 12, and 13 teams submitting different solutions for these three tasks, respectively. This paper presents a concise summary and analysis of the top-performing solutions and results across all challenge tasks. These solutions could provide practical guidance for developing accurate classification and segmentation models for image quality assessment and DR diagnosis using UW-OCTA images, potentially improving the diagnostic capabilities of healthcare professionals. The dataset has been released to support the development of computer-aided diagnostic systems for DR evaluation.
Collapse
Affiliation(s)
- Bo Qian
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | - Xiangning Wang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Tingyao Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yixiao Jin
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yilan Wu
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yang Wen
- School of Electronic and Information Engineering, Shenzhen University, Shenzhen 518060, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | | | | | - Sungjin Choi
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Seoyoung Shin
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Felix Krause
- Johannes Kepler University Linz, Linz 4040, Austria
| | | | - Junlin Hou
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
| | - Rui Feng
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Yihao Li
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Mostafa El Habib Daho
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Qiang Wu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Ping Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Xiaokang Yang
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yiyu Cai
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| |
Collapse
|
8
|
Vilela MAP, Arrigo A, Parodi MB, da Silva Mengue C. Smartphone Eye Examination: Artificial Intelligence and Telemedicine. Telemed J E Health 2024; 30:341-353. [PMID: 37585566 DOI: 10.1089/tmj.2023.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background: The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods: In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results: There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions: The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population.
Collapse
Affiliation(s)
| | - Alessandro Arrigo
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Carolina da Silva Mengue
- Post-Graduation Ophthalmological School, Ivo Corrêa-Meyer/Cardiology Institute, Porto Alegre, Brazil
| |
Collapse
|
9
|
Sadikin IS, Lestari YD, Victor AA. The role of cadre in the community on diabetic retinopathy management and its challenges in low-middle income countries: a scoping review. BMC Public Health 2024; 24:177. [PMID: 38225623 PMCID: PMC10789068 DOI: 10.1186/s12889-024-17652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Diabetes is a serious public health problem, with low- and middle-income countries (LMICs) bearing over 80% of the burden. Diabetic retinopathy (DR) is one of the most prevalent diabetic microvascular problems, and early diagnosis through eye screening programs for people with diabetes is critical to prevent vision impairment and blindness. Community-based treatments, including non-physician cadres have been recommended to enhance DR care. METHODS The review protocol was determined and scoping review was conducted.The population, concept, and context were "cadre", "role of cadre in the management of DR", and LMICs". Data were collected from databases and searches, including grey literature. RESULTS Cadre can motivate people to attend a diabetic eye screening event when the rate of eye examinations is about six times higher than before the start of the intervention. Health education is a possible area for task sharing, and the cadre reported could also perform the task of vision testing. The cadre could be a good supporter and a good reminder for society. However, several challenges have been faced in this study and inadequate infrastructure is the foremost challenge found in this study. Other challenges encountered in the studies include poverty, lack of community awareness, trust issues, and low education levels contributing to poor health. CONCLUSION The current study highlighted significant gaps in the literature, which focus on the role of cadre as a community-based intervention in managing DR in LMICs. Further research is needed to develop evidence to support cost-effective screening services and cadre-related policy development in LMICs.
Collapse
Affiliation(s)
- Irma Suwandi Sadikin
- Residency Program in Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Yeni Dwi Lestari
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
| | - Andi Arus Victor
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| |
Collapse
|
10
|
Li H, Li G, Li N, Liu C, Yuan Z, Gao Q, Hao S, Fan S, Yang J. Cost-effectiveness analysis of artificial intelligence-based diabetic retinopathy screening in rural China based on the Markov model. PLoS One 2023; 18:e0291390. [PMID: 37971984 PMCID: PMC10653408 DOI: 10.1371/journal.pone.0291390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023] Open
Abstract
This study assessed the cost-effectiveness of different diabetic retinopathy (DR) screening strategies in rural regions in China by using a Markov model to make health economic evaluations. In this study, we determined the structure of a Markov model according to the research objectives, which required parameters collected through field investigation and literature retrieval. After perfecting the model with parameters and assumptions, we developed a Markov decision analytic model according to the natural history of DR in TreeAge Pro 2011. For this model, we performed Markov cohort and cost-effectiveness analyses to simulate the probabilistic distributions of different developments in DR and the cumulative cost-effectiveness of artificial intelligence (AI)-based screening and ophthalmologist screening for DR in the rural population with diabetes mellitus (DM) in China. Additionally, a model-based health economic evaluation was performed by using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios. Last, one-way and probabilistic sensitivity analyses were performed to assess the stability of the results. From the perspective of the health system, compared with no screening, AI-based screening cost more (the incremental cost was 37,257.76 RMB (approximately 5,211.31 US dollars)), but the effect was better (the incremental utility was 0.33). Compared with AI-based screening, the cost of ophthalmologist screening was higher (the incremental cost was 14,886.76 RMB (approximately 2,070.19 US dollars)), and the effect was worse (the incremental utility was -0.31). Compared with no screening, the incremental cost-effectiveness ratio (ICER) of AI-based DR screening was 112,146.99 RMB (15,595.47 US dollars)/QALY, which was less than the threshold for the ICER (< 3 times the per capita gross domestic product (GDP), 217,341.00 RMB (30,224.03 US dollars)). Therefore, AI-based screening was cost-effective, which meant that the increased cost for each additional quality-adjusted life year was merited. Compared with no screening and ophthalmologist screening for DR, AI-based screening was the most cost-effective, which not only saved costs but also improved the quality of life of diabetes patients. Popularizing AI-based DR screening strategies in rural areas would be economically effective and feasible and can provide a scientific basis for the further formulation of early screening programs for diabetic retinopathy.
Collapse
Affiliation(s)
- Huilin Li
- Department of Ophthalmology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, China
| | - Guanyan Li
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
- Shenzhen Longgang Otorhinolaryngology Hospital, Shenzhen, 518100, China
| | - Na Li
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Changyan Liu
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Ziyou Yuan
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Qingyue Gao
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Shaofeng Hao
- Department of Ophthalmology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, China
| | - Shengfu Fan
- Department of Foreign Languages, Changzhi Medical College, Changzhi, 046000, China
| | - Jianzhou Yang
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, 046000, China
| |
Collapse
|
11
|
Olawoye OO, Ha TH, Pham N, Nguyen L, Cherwek DH, Fowobaje KR, Ross C, Coote M, Chan VF, Kahook M, Peto T, Azuara-Blanco A, Congdon N. Impact of a short online course on the accuracy of non-ophthalmic diabetic retinopathy graders in recognising glaucomatous optic nerves in Vietnam. BMJ Open 2023; 13:e076623. [PMID: 37945295 PMCID: PMC10649381 DOI: 10.1136/bmjopen-2023-076623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/12/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam. METHODS This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one-to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed. RESULTS Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders' mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p<0.001), and post-training score did not differ from ophthalmologists (58.7±15.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p<0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p<0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores. CONCLUSION Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one-to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance.
Collapse
Affiliation(s)
- Olusola Oluyinka Olawoye
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ngoc Pham
- ORBIS International, New York, New York, USA
| | - Lam Nguyen
- Hanoi Medical University, Hanoi, Viet Nam
| | | | | | - Craig Ross
- Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Michael Coote
- Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Ving Fai Chan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Malik Kahook
- University of Colorado at Colorado Springs, Colorado, UK
| | - Tunde Peto
- Faculty of Medicine Health and Life Sciences, Queen's University Belfast, Belfast, Belfast, UK
| | | | - Nathan Congdon
- Department of Ophthalmology and Public Health, Queen's University Belfast, Belfast, UK
- Orbis International NY USA, New York, New York, USA
- Department of Ophthalmology, Zhongshan Ophthalmic Centre, Guangzhou, People's Republic of China
| |
Collapse
|
12
|
Zungu T, Mdala S, Kayange P, Fernando E, Twabi H, Jumbe A, Kumwenda J, Muula A. Uptake of diabetic retinopathy screening at a secondary level facility in Malawi. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002567. [PMID: 37939026 PMCID: PMC10631633 DOI: 10.1371/journal.pgph.0002567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
Diabetic retinopathy (DR) is a common microvascular complication of long-standing diabetes mellitus (DM). DR screening is a cost-effective intervention for preventing blindness from DR. We conducted a cross-sectional study to investigate the uptake and the predictors of uptake of annual DR screening in an opportunistic DR screening programme at a secondary-level diabetes clinic in Southern Malawi. Consecutive patients were interviewed using a structured questionnaire to record their demographic characteristics, medical details and data regarding; the frequency of clinic visits, knowledge of existence of DR screening services and a history of referral for DR screening in the prior one year. Univariate binary logistic regression was used to investigate predictors of DR screening uptake over the prior one year. Explanatory variables that had a P-value of < 0.1 were included into a multivariate logistic regression model. All variables that had a p-value of <0.05 were considered to be statistically significant. We recruited 230 participants over three months with a median age of 52.5 years (IQR 18-84) and a median duration of diabetes of 4 years (IQR 1-7). The average interval of clinic visits was 1.2 months (SD ± 0.43) and only 59.1% (n = 139) of the participants were aware of the existence of diabetic retinopathy screening services at the facility. The uptake for DR screening over one year was 20% (n = 46). The strongest predictors of uptake on univariate analysis were awareness of the existence of DR screening services (OR 10.05, P <0.001) and a history of being referred for DR screening (OR 9.02, P <0.001) and these remained significant on multivariable analysis. Interventions to improve uptake for DR screening should promote referral of patients for DR screening and strengthen knowledge about the need and availability of DR screening services.
Collapse
Affiliation(s)
- Thokozani Zungu
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Shaffi Mdala
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Petros Kayange
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Halima Twabi
- Department of Mathematical Sciences, University of Malawi, Zomba, Malawi
| | | | - Johnstone Kumwenda
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Adamson Muula
- Kamuzu University of Health Sciences, Blantyre, Malawi
| |
Collapse
|
13
|
Zhelev Z, Peters J, Rogers M, Allen M, Kijauskaite G, Seedat F, Wilkinson E, Hyde C. Test accuracy of artificial intelligence-based grading of fundus images in diabetic retinopathy screening: A systematic review. J Med Screen 2023; 30:97-112. [PMID: 36617971 PMCID: PMC10399100 DOI: 10.1177/09691413221144382] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To systematically review the accuracy of artificial intelligence (AI)-based systems for grading of fundus images in diabetic retinopathy (DR) screening. METHODS We searched MEDLINE, EMBASE, the Cochrane Library and the ClinicalTrials.gov from 1st January 2000 to 27th August 2021. Accuracy studies published in English were included if they met the pre-specified inclusion criteria. Selection of studies for inclusion, data extraction and quality assessment were conducted by one author with a second reviewer independently screening and checking 20% of titles. Results were analysed narratively. RESULTS Forty-three studies evaluating 15 deep learning (DL) and 4 machine learning (ML) systems were included. Nine systems were evaluated in a single study each. Most studies were judged to be at high or unclear risk of bias in at least one QUADAS-2 domain. Sensitivity for referable DR and higher grades was ≥85% while specificity varied and was <80% for all ML systems and in 6/31 studies evaluating DL systems. Studies reported high accuracy for detection of ungradable images, but the latter were analysed and reported inconsistently. Seven studies reported that AI was more sensitive but less specific than human graders. CONCLUSIONS AI-based systems are more sensitive than human graders and could be safe to use in clinical practice but have variable specificity. However, for many systems evidence is limited, at high risk of bias and may not generalise across settings. Therefore, pre-implementation assessment in the target clinical pathway is essential to obtain reliable and applicable accuracy estimates.
Collapse
Affiliation(s)
- Zhivko Zhelev
- Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jaime Peters
- Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Christopher Hyde
- Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
14
|
Sauesund ES, Jørstad ØK, Brunborg C, Moe MC, Erke MG, Fosmark DS, Petrovski G. A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results. Biomedicines 2023; 11:1222. [PMID: 37189840 PMCID: PMC10135488 DOI: 10.3390/biomedicines11041222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway. METHODS This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR. RESULTS The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group. CONCLUSIONS This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).
Collapse
Affiliation(s)
- Ellen Steffenssen Sauesund
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0450 Oslo, Norway
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Dag Sigurd Fosmark
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| |
Collapse
|
15
|
[Photo-based examination for diabetic eye pathologies in a German ophthalmological practice without personal doctor-patient contact]. DIE OPHTHALMOLOGIE 2023; 120:301-308. [PMID: 36169715 DOI: 10.1007/s00347-022-01737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND An increasing number of patients suffering from diabetes require regular ophthalmological check-ups to diagnose and/or treat potential diabetic retinal disease. Some countries have already implemented systematic fundus assessments including artificial intelligence-based programs in order to detect sight-threatening retinopathy. The aim of this study was to improve the detection of diabetic fundus changes in Germany without examination by a doctor and to create an easy access to ophthalmological examinations. MATERIAL AND METHODS In this prospective monocentric study 93 patients in need for a routine check-up for diabetic retinopathy were included. The study participants took up an offer of an examination (visual examination, non-mydriatic camera-based fundus examination) without doctor-patient contact. Patient satisfaction with the organization and examinations was assessed using a questionnaire. RESULTS The mean age was 53.5 years (SD 13.6 years, 49.5% female) and 17 eyes (18.3%) showed a diabetic retinopathy which was detected using a camera-based examination. Within the small sample, no patient had to repeat the examination due to poor image quality. All categories of the questionnaire showed a good to very good satisfaction, indicating a high acceptance of the other examination form that took place at the ophthalmologist's premises. CONCLUSION In our study in an ophthalmological practice a high level of acceptance among the patients interested in the screening for diabetic retinopathy without any direct patient-doctor contact was achieved. Our study shows a very good acceptance and feasibility. Future use of artificial intelligence in clinical practice may help to be able to screen many more patients as in this study imaging quality was very good.
Collapse
|
16
|
Invernizzi A, Chhablani J, Viola F, Gabrielle PH, Zarranz-Ventura J, Staurenghi G. Diabetic retinopathy in the pediatric population: Pathophysiology, screening, current and future treatments. Pharmacol Res 2023; 188:106670. [PMID: 36681366 DOI: 10.1016/j.phrs.2023.106670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Diabetic retinopathy (DR) is a sight threatening complication of diabetes mellitus (DM). The incidence of DR in the pediatric population has increased in the last two decades and it is expected to further rise in the future, following the increase in DM prevalence and obesity in youth. As early stages of the retinal disease are asymptomatic, screening programs are of extreme importance to guarantee a prompt diagnosis and avoid progression to more advanced, sight threatening stages. The management of DR comprises a wide range of actions starting from glycemic control, continuing with systemic and local medical treatments, up to para-surgical and surgical approaches to deal with the more aggressive complications. In this review we will describe the pathophysiology of DR trying to understand all the possible targets for currently available or future treatments. We will briefly consider the impact of screening techniques, screening strategies and their social and economic impact. Finally a large part of the review will be dedicated to medical and surgical treatments for DR including both currently available and under development therapies. Most of the available data in the literature on DR are focused on the adult population. The aim of our work is to provide clinicians and researchers with a comprehensive overview of the state of the art regarding DR in the pediatric population, considering the increasing numbers of this diseases in youth and the inevitable consequences that such a chronic disease could have if poorly managed in children.
Collapse
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia.
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierre Henry Gabrielle
- Department of Ophthalmology, University Hospital, 14 rue Paul Gaffarel, 21079 Dijon, France
| | - Javier Zarranz-Ventura
- Institut Clínic of Ophthalmology (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| |
Collapse
|
17
|
Samanta A, Mauntana S, Barsi Z, Yarlagadda B, Nelson PC. Is your vision blurry? A systematic review of home-based visual acuity for telemedicine. J Telemed Telecare 2023; 29:81-90. [PMID: 33222600 DOI: 10.1177/1357633x20970398] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Visual acuity (VA) testing is a vital screening tool for the assessment of ocular function. The coronavirus 2019 pandemic has caused an immediate need for synchronous telemedicine in all specialties, including ophthalmology. While a plethora of mobile VA applications exist, there is no consensus as to what technology can accurately and reproducibly measure a patient's vision at home. METHODS A systematic literature search was performed in April 2020 using PubMed, Embase and Medline, identifying English publications from 2010 to 2020 on remote VA tests: 4338 articles were identified and 14 were ultimately included in the review. RESULTS Of those 14, the highest quality studies, best reproducibility and correlation with in-clinic acuities measured were found using the Peek Acuity application. The studies included patients throughout the world aged 3-97, with and without correction, with known ocular pathology.The Peek Acuity studies measured distance vision on a Samsung Galaxy S3 with a mean difference of 0.055 Logarithm of the Minimum Angle of Resolution (LogMAR) for home testing compared with the Early Treatment Diabetic Retinopathy Study (ETDRS). Test-retest variability was ±0.029 LogMAR for 95% confidence interval limits. DISCUSSION There can be one or more lines of variability in vision testing in a clinical setting using reference standard ETDRS and clinical standard Snellen charts. Test-retest reliability is not perfect even on standard clinical charts (variation up to 0.48 LogMAR). Of the technologies reviewed, Peek Acuity home testing had the greatest correlation with ETDRS clinical vision and high test-retest reliability. Peek Acuity performed no worse than Snellen and ETDRS charts.
Collapse
Affiliation(s)
- Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Shielah Mauntana
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Zahra Barsi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Bina Yarlagadda
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Patricia C Nelson
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| |
Collapse
|
18
|
Yang H, Xia M, Liu Z, Xing Y, Zhao W, Li Y, Wang M, Zhao Z. Nomogram for prediction of diabetic retinopathy in patients with type 2 diabetes mellitus: A retrospective study. J Diabetes Complications 2022; 36:108313. [PMID: 36183450 DOI: 10.1016/j.jdiacomp.2022.108313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a nomogram for the risk of diabetic retinopathy (DR) among type 2 diabetes mellitus (T2DM). METHODS Questionnaires, physical examinations and biochemical tests were performed on 5900 T2DM patients in the Second Hospital of Shijiazhuang. The least absolute shrinkage and selection operator regression was used to optimize feature selection, and the importance of selected features was analyzed by random forest. Logistic regression was performed with selected features, and the nomogram was established based on the results. The Harrell's C-statistic, bootstrap-corrected C-statistic, area under curve (AUC), calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) were used to validate the discrimination, calibration and clinical usefulness of the nomogram, and further assessment was running by external validation. RESULTS Predictors included duration of diabetes, diabetic neuropathy, diabetic kidney disease, diabetic foot, hyperlipidemia, hypoglycemic drugs, glycated albumin, Lactate dehydrogenase. The model displayed medium predictive power with a Harrell's C-statistic of 0.820, bootstrap-corrected C-statistic of 0.813 and AUC of 0.820 in the training set, and which was respectively 0.842, 0.835 and 0.842 in the validation set. The calibration curve displayed good agreement (P > 0.05). The DCA and CIC showed that the nomogram could be applied clinically if the risk threshold is between 2 % and 75 % and 2 %-88 % in validation set. CONCLUSIONS This nomogram incorporating 8 features is useful to predict the risk of DR in T2DM patients.
Collapse
Affiliation(s)
- Hongyan Yang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Miao Xia
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Zanchao Liu
- Hebei Province Key Laboratory of Basic Medicine for Diabetes/Shijiazhuang Second Hospital, Shijiazhuang 050051, China
| | - Yuwei Xing
- Hebei Province Key Laboratory of Basic Medicine for Diabetes/Shijiazhuang Second Hospital, Shijiazhuang 050051, China
| | - Weili Zhao
- Hebei Province Key Laboratory of Basic Medicine for Diabetes/Shijiazhuang Second Hospital, Shijiazhuang 050051, China
| | - Yang Li
- Hebei Province Key Laboratory of Basic Medicine for Diabetes/Shijiazhuang Second Hospital, Shijiazhuang 050051, China
| | - Minzhen Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China.
| | - Zengyi Zhao
- Hebei Province Key Laboratory of Basic Medicine for Diabetes/Shijiazhuang Second Hospital, Shijiazhuang 050051, China.
| |
Collapse
|
19
|
Yadav M, Tanwar M. Impact of COVID-19 on glaucoma management: A review. FRONTIERS IN OPHTHALMOLOGY 2022; 2:1003653. [PMID: 38983512 PMCID: PMC11182257 DOI: 10.3389/fopht.2022.1003653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 07/11/2024]
Abstract
Glaucoma is the leading cause of irreversible vision loss and the second leading cause of blindness worldwide. The rapid transmission of SARS-CoV-2virus compelled governments to concentrate their efforts on emergency units to treat the large number of cases that arose due to the Covid-19 outbreak. As a result, many chronically ill patients were left without access to medical care. The progression of glaucoma in previously diagnosed cases has been accelerated; due to this, some have lost their vision. Evaluation of Covid-19's effect on glaucoma treatment was one goal of this study. We used search phrases like "COVID-19," "telemedicine," and "glaucoma" to find published papers on COVID-19 and glaucoma. Artificial Intelligence (AI) may be the answer to the unanswered questions that arose due to this pandemic crisis. The benefits and drawbacks of AI in the context of teliglaucoma have been thoroughly examined. These AI-related ideas have been floating around for some time. We hope that Covid-19's enormous revisions will provide them with the motivation to move forward and significantly improve services. Despite the devastation the pandemic has caused, we are hopeful that eye care services will be better prepared and better equipped to avoid the loss of sight due to glaucoma in future.
Collapse
Affiliation(s)
| | - Mukesh Tanwar
- Department of Genetics, Maharshi Dayanand University, Rohtak, India
| |
Collapse
|
20
|
Nadeem MW, Goh HG, Hussain M, Liew SY, Andonovic I, Khan MA. Deep Learning for Diabetic Retinopathy Analysis: A Review, Research Challenges, and Future Directions. SENSORS (BASEL, SWITZERLAND) 2022; 22:6780. [PMID: 36146130 PMCID: PMC9505428 DOI: 10.3390/s22186780] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 05/12/2023]
Abstract
Deep learning (DL) enables the creation of computational models comprising multiple processing layers that learn data representations at multiple levels of abstraction. In the recent past, the use of deep learning has been proliferating, yielding promising results in applications across a growing number of fields, most notably in image processing, medical image analysis, data analysis, and bioinformatics. DL algorithms have also had a significant positive impact through yielding improvements in screening, recognition, segmentation, prediction, and classification applications across different domains of healthcare, such as those concerning the abdomen, cardiac, pathology, and retina. Given the extensive body of recent scientific contributions in this discipline, a comprehensive review of deep learning developments in the domain of diabetic retinopathy (DR) analysis, viz., screening, segmentation, prediction, classification, and validation, is presented here. A critical analysis of the relevant reported techniques is carried out, and the associated advantages and limitations highlighted, culminating in the identification of research gaps and future challenges that help to inform the research community to develop more efficient, robust, and accurate DL models for the various challenges in the monitoring and diagnosis of DR.
Collapse
Affiliation(s)
- Muhammad Waqas Nadeem
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia
| | - Hock Guan Goh
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia
| | - Muzammil Hussain
- Department of Computer Science, School of Systems and Technology, University of Management and Technology, Lahore 54000, Pakistan
| | - Soung-Yue Liew
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia
| | - Ivan Andonovic
- Department of Electronic and Electrical Engineering, Royal College Building, University of Strathclyde, 204 George St., Glasgow G1 1XW, UK
| | - Muhammad Adnan Khan
- Pattern Recognition and Machine Learning Lab, Department of Software, Gachon University, Seongnam 13557, Korea
- Faculty of Computing, Riphah School of Computing and Innovation, Riphah International University, Lahore Campus, Lahore 54000, Pakistan
| |
Collapse
|
21
|
Curran DM, Kim BY, Withers N, Shepard DS, Brady CJ. Telehealth Screening for Diabetic Retinopathy: Economic Modeling Reveals Cost Savings. Telemed J E Health 2022; 28:1300-1308. [PMID: 35073213 PMCID: PMC9508450 DOI: 10.1089/tmj.2021.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: The use of telehealth screening (TS) for diabetic retinopathy (DR) consists of fundus photography in a primary care setting with remote interpretation of images. TS for DR is known to increase screening utilization and reduce vision loss compared with standard in-person conventional diabetic retinal exam (CDRE). Anti-vascular endothelial growth factor intravitreal injections have become standard of care for the treatment of DR, but they are expensive. We investigated whether TS for DR is cost-effective when DR management includes intravitreal injections using national data. Materials and Methods: We compared cost and effectiveness of TS and CDRE using decision-tree analysis and probabilistic sensitivity analysis with Monte Carlo simulation. We considered the disability weight (DW) of vision impairment and 1-year direct medical costs of managing patients based on Medicare allowable rates and clinical trial data. Primary outcomes include incremental costs and incremental effectiveness. Results: The average annual direct cost of eye care was $196 per person for TS and $275 for CDRE. On average, TS saves $78 (28%) compared with CDRE and was cost saving in 88.9% of simulations. The average DW outcome was equivalent in both groups. Discussion: Although this study was limited by a 1-year time horizon, it provides support that TS for DR can reduce costs of DR management despite expensive treatment with anti-VEGF agents. TS for DR is equally effective as CDRE at preserving vision. Conclusions: Annual TS for DR is cost saving and equally effective compared with CDRE given a 1-year time horizon.
Collapse
Affiliation(s)
- Delaney M. Curran
- Division of Ophthalmology, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Brian Y. Kim
- Division of Ophthalmology, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Division of Ophthalmology, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Natasha Withers
- Ambulatory Care, Porter Medical Center, University of Vermont Health Network, Middlebury, Vermont, USA
| | - Donald S. Shepard
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Christopher J. Brady
- Division of Ophthalmology, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Division of Ophthalmology, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
- Vermont Center on Behavior and Health, Larner College of Medicine, Burlington, Vermont, USA
| |
Collapse
|
22
|
Kumar A, Tewari AS. Risk Identification of Diabetic Macular Edema Using E-Adoption of Emerging Technology. INTERNATIONAL JOURNAL OF E-ADOPTION 2022. [DOI: 10.4018/ijea.310000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The accumulation of the blood leaks on the retina is known as diabetic macular edema (DME), which can result in irreversible blindness. Early diagnosis and therapy can stop DME. This study presents an e-adoption of emerging technology such as RadioDense model for detecting and classifying DME from retinal fundus images. The proposed model employs a modified version of DenseNet121, radiomics features, and the gradient boosting classifier. The authors evaluated many classifiers on the concatenated features. The efficacy of the classifier is determined by comparing each classifier's accuracy values. According to the evaluation results, the concatenated features extraction using gradient boosting classifier outperforms all other classifiers on the IDRiD dataset. For multi-class classification, the suggested electronic adoption of emerging technology such as RadioDense model outperformed these classifiers and attained an accuracy of 87.4%. It can help to decrease the strain of ophthalmologists diagnosing the DME during locking and unlocking the worldwide lockdown.
Collapse
Affiliation(s)
- Amit Kumar
- National Institute of Technology, Patna, India
| | | |
Collapse
|
23
|
Pareja-Ríos A, Ceruso S, Romero-Aroca P, Bonaque-González S. A New Deep Learning Algorithm with Activation Mapping for Diabetic Retinopathy: Backtesting after 10 Years of Tele-Ophthalmology. J Clin Med 2022; 11:jcm11174945. [PMID: 36078875 PMCID: PMC9456446 DOI: 10.3390/jcm11174945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
We report the development of a deep learning algorithm (AI) to detect signs of diabetic retinopathy (DR) from fundus images. For this, we use a ResNet-50 neural network with a double resolution, the addition of Squeeze–Excitation blocks, pre-trained in ImageNet, and trained for 50 epochs using the Adam optimizer. The AI-based algorithm not only classifies an image as pathological or not but also detects and highlights those signs that allow DR to be identified. For development, we have used a database of about half a million images classified in a real clinical environment by family doctors (FDs), ophthalmologists, or both. The AI was able to detect more than 95% of cases worse than mild DR and had 70% fewer misclassifications of healthy cases than FDs. In addition, the AI was able to detect DR signs in 1258 patients before they were detected by FDs, representing 7.9% of the total number of DR patients detected by the FDs. These results suggest that AI is at least comparable to the evaluation of FDs. We suggest that it may be useful to use signaling tools such as an aid to diagnosis rather than an AI as a stand-alone tool.
Collapse
Affiliation(s)
- Alicia Pareja-Ríos
- Department of Ophthalmology, University Hospital of the Canary Islands, 38320 San Cristóbal de La Laguna, Spain
| | - Sabato Ceruso
- School of Engineering and Technology, University of La Laguna, 38200 San Cristóbal de La Laguna, Spain
| | - Pedro Romero-Aroca
- Ophthalmology Department, University Hospital Sant Joan, Institute of Health Research Pere Virgili (IISPV), Universitat Rovira & Virgili, 43002 Tarragona, Spain
| | - Sergio Bonaque-González
- Instituto de Astrofísica de Canarias, 38205 San Cristóbal de La Laguna, Spain
- Correspondence:
| |
Collapse
|
24
|
Fernandes AG, Ferraz AN, Brant R, Malerbi FK. Diabetic retinopathy screening and treatment through the Brazilian National Health Insurance. Sci Rep 2022; 12:13941. [PMID: 35977971 PMCID: PMC9385734 DOI: 10.1038/s41598-022-18054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
The current study aimed to investigate diabetic retinopathy (DR) screening and treatment coverages among diabetic patients evaluated through the Brazilian National Health Insurance from 2014 to 2019. The Brazilian Public Health System Information Database was used as the primary data source. DR screening coverage was calculated as the rate of procedures of clinical dilated fundus exam and color fundus photograph over the number of diabetic patients. DR treatment coverage was calculated as the rate of procedures of intravitreal injection, photocoagulation, and panretinal photocoagulation over the number of diabetic patients presumably in need of DR treatment. The overall screening coverage increased from 12.1% in 2014 to 21.2% in 2019 (p < 0.001) with substantial regional discrepancies so that North region was the only one with no changes along the period. The overall treatment coverage increased from 27.7% in 2014 to 44.1% in 2019, with Southeast and Midwest absorbing the demand for service from the North, Northeast and South. Despite an improvement along the past years, both screening and treatment coverages for DR in diabetes patients are ineffective in Brazil. Public health policies should address resources disparities throughout the country aiming to offer same healthcare conditions to patients regardless their geographic location.
Collapse
Affiliation(s)
- Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil. .,Department of Anthropology and Archaeology, University of Calgary, Calgary, AB, Canada.
| | - Aline Nunes Ferraz
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil
| | - Rodrigo Brant
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil
| | - Fernando Korn Malerbi
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil
| |
Collapse
|
25
|
Bortoli JQ, Silber PC, Picetti E, Silva CFD, Pakter HM. Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
26
|
Changes in the Epidemiology of Diabetic Retinopathy in Spain: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10071318. [PMID: 35885844 PMCID: PMC9320037 DOI: 10.3390/healthcare10071318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of the present study was to determine the prevalence and incidence of diabetic retinopathy (DR) and its changes in the last 20 years in type 2 diabetes mellitus (T2DM) patients in Spain. Methods. A systematic review with a meta-analysis was carried out on the studies published between 2001–2020 on the prevalence and incidence of DR and sight-threatening diabetic retinopathy (STDR) in Spain. The articles included were selected from four databases and publications of the Spanish Ministry of Health and Regional Health Care System (RHCS). The meta-analysis to determine heterogeneity and bias between studies was carried out with the MetaXL 4.0. Results. Since 2001, we have observed an increase in the detection of patients with DM, and at the same time, screening programs for RD have been launched; thus, we can deduce that the increase in the detection of patients with DM, many of them in the initial phases, far exceeds the increased detection of patients with DR. The prevalence of DR was higher between 2001 and 2008 with values of 28.85%. These values decreased over the following period between 2009 and 2020 with a mean of 15.28%. Similarly the STDR prevalence decrease from 3.67% to 1.92% after 2008. The analysis of the longitudinal studies determined that the annual DR incidence was 3.83%, and the STDR annual incidence was 0.41%. Conclusion. In Spain, for T2DM, the current prevalence of DR is 15.28% and 1.92% forSTDR. The annual incidence of DR is 3.83% and is 0.41% for STDR.
Collapse
|
27
|
McMurry TL, Lobo JM, Kang H, Kim S, Balkrishnan R, Anderson R, McCall A, Sohn MW. Annual wellness visits are associated with increased use of preventive services in patients with diabetes living in the Diabetes Belt. DIABETES EPIDEMIOLOGY AND MANAGEMENT 2022; 7. [PMID: 35991000 PMCID: PMC9387346 DOI: 10.1016/j.deman.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To examine whether Annual Wellness Visits (AWVs) were associated with increased use of preventive services in Medicare patients with diabetes living in the Diabetes Belt. Methods: We used a case-control design where outcomes were utilization of preventive services recommended for patients with diabetes (foot exam, eye exam, A1c test, and microalbuminuria test) and the exposure was AWVs using data for Medicare patients with diabetes in 2014 − 2015 residing in the Diabetes Belt (N = 412,009). Results: Only 13.4% of patients in 2014 and 17.4% in 2015 used AWVs. Eye exams (61% vs 53%), foot exams (93% vs 79%), A1c tests (81% vs 71%), and microalbuminuria tests (45% vs 28%) were more common among patients who had an AWV in the preceding year compared with those who did not. These differences remained significant after adjusting for patient demographics, comorbidities, county level medical resources, and geographic factors. Conclusions: AWVs were significantly associated with increased preventive care use among patients with diabetes living in the Diabetes Belt. Low AWV utilization by patients with diabetes in and around the Diabetes Belt is concerning.
Collapse
|
28
|
Held LA, Wewetzer L, Steinhäuser J. Determinants of the implementation of an artificial intelligence-supported device for the screening of diabetic retinopathy in primary care - a qualitative study. Health Informatics J 2022; 28:14604582221112816. [PMID: 35921547 DOI: 10.1177/14604582221112816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetic retinopathy is a microvascular complication of diabetes mellitus that is usually asymptomatic in the early stages. Therefore, its timely detection and treatment are essential. First pilot projects exist to establish a smartphone-based and AI-supported screening of DR in primary care. This study explored health professionals' perceptions of potential barriers and enablers of using a screening such as this in primary care to understand the mechanisms that could influence implementation into routine clinical practice. Semi-structured telephone interviews were conducted and analysed with the help of qualitative analysis of Mayring. The following main influencing factors to implementation have been identified: personal attitude, organisation, time, financial factors, education, support, technical requirement, influence on profession and patient welfare. Most determinants could be relocated in the behaviour change wheel, a validated implementation model. Further research on the patients' perspective and a ranking of the determinants found is needed.
Collapse
Affiliation(s)
- Linda A Held
- Institute of Family Medicine, 54360University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Larisa Wewetzer
- Institute of Family Medicine, 54360University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, 54360University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| |
Collapse
|
29
|
Abouzid MR, Elshafei SM, Elkhawas I, Elbana MK. Applications of Telemedicine in the Middle East and North Africa Region: Benefits Gained and Challenges Faced. Cureus 2022; 14:e26611. [PMID: 35936169 PMCID: PMC9355518 DOI: 10.7759/cureus.26611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
Abstract
Information and communication technology has left a print on all fields of life, including medicine and the health care system. Telemedicine is the perfect way to ensure adequate healthcare delivery to all people at any time, particularly during pandemics, regardless of any geographic or economic considerations. This article investigates the different types, categories, and benefits in addition to the barriers to telemedicine implementation, especially in the Middle East and North Africa (MENA) region. After a thorough review of medical literature related to telemedicine using PubMed, Google Scholar, and some other gray literature, it has been found that telemedicine has been involved in almost all medical specialties with a positive influence on healthcare delivery and medical education and research. It had a major role during the COVID-19 pandemic. However, many obstacles prevent its proper application and need to be addressed carefully by the government and relevant authorities. Due to the rapidly growing population, unequal distribution of healthcare services, and social distancing of the COVID-19 pandemic, the role of telemedicine has become increasingly essential. Regarding medical education and research, telemedicine facilitates the exchange of information and ideas between physicians and professionals from all over the world, bringing these various minds together on a single platform.
Collapse
Affiliation(s)
- Mohamed R Abouzid
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
| | - Shorouk M Elshafei
- Internal Medicine, Mansoura University Faculty of Medicine, Mansoura, EGY
| | | | | |
Collapse
|
30
|
Jang HN, Moon MK, Koo BK. Prevalence of Diabetic Retinopathy in Undiagnosed Diabetic Patients: A Nationwide Population-Based Study. Diabetes Metab J 2022; 46:620-629. [PMID: 35193173 PMCID: PMC9353559 DOI: 10.4093/dmj.2021.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We investigated the prevalence of diabetic retinopathy (DR) in patients with undiagnosed diabetes through a nationwide survey, compared to those with known diabetes. METHODS Among the participants of the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2017 to 2018, individuals aged ≥40 years with diabetes and fundus exam results were enrolled. Sampling weights were applied to represent the entire Korean population. Newly detected diabetes patients through KNHANES were classified under "undiagnosed diabetes." RESULTS Among a total of 9,108 participants aged ≥40 years, 951 were selected for analysis. Of them, 31.3% (standard error, ±2.0%) were classified under "undiagnosed diabetes." The prevalence of DR in patients with known and undiagnosed diabetes was 24.5%±2.0% and 10.7%±2.2%, respectively (P<0.001). The DR prevalence increased with rising glycosylated hemoglobin (HbA1c) levels in patients with known and undiagnosed diabetes (P for trend=0.001 in both). Among those with undiagnosed diabetes, the prevalence of DR was 6.9%±2.1%, 8.0%±3.4%, 5.6%±5.7%, 16.7%±9.4%, and 42.6%±14.8% for HbA1c levels of <7.0%, 7.0%-7.9%, 8.0%-8.9%, 9.0%-9.9%, and ≥10.0% respectively. There was no difference in the prevalence of hypertension, dyslipidemia, hypertriglyceridemia, or obesity according to the presence or absence of DR. CONCLUSION About one-third of patients with diabetes were unaware of their diabetes, and 10% of them have already developed DR. Considering increasing the prevalence of DR according to HbA1c level was found in patients with undiagnosed diabetes like those with known diabetes, screening and early detection of diabetes and DR are important.
Collapse
Affiliation(s)
- Han Na Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Corresponding author: Bo Kyung Koo https://orcid.org/0000-0002-6489-2656 Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea E-mail:
| |
Collapse
|
31
|
Long-term prediction models for vision-threatening diabetic retinopathy using medical features from data warehouse. Sci Rep 2022; 12:8476. [PMID: 35589921 PMCID: PMC9119940 DOI: 10.1038/s41598-022-12369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
We sought to evaluate the performance of machine learning prediction models for identifying vision-threatening diabetic retinopathy (VTDR) in patients with type 2 diabetes mellitus using only medical data from data warehouse. This is a multicenter electronic medical records review study. Patients with type 2 diabetes screened for diabetic retinopathy and followed-up for 10 years were included from six referral hospitals sharing same electronic medical record system (n = 9,102). Patient demographics, laboratory results, visual acuities (VAs), and occurrence of VTDR were collected. Prediction models for VTDR were developed using machine learning models. F1 score, accuracy, specificity, and area under the receiver operating characteristic curve (AUC) were analyzed. Machine learning models revealed F1 score, accuracy, specificity, and AUC values of up 0.89, 0.89.0.95, and 0.96 during training. The trained models predicted the occurrence of VTDR at 10-year with F1 score, accuracy, and specificity up to 0.81, 0.70, and 0.66, respectively, on test set. Important predictors included baseline VA, duration of diabetes treatment, serum level of glycated hemoglobin and creatinine, estimated glomerular filtration rate and blood pressure. The models could predict the long-term occurrence of VTDR with fair performance. Although there might be limitation due to lack of funduscopic findings, prediction models trained using medical data can facilitate proper referral of subjects at high risk for VTDR to an ophthalmologist from primary care.
Collapse
|
32
|
Rigato M, Nollino L, Tiago A, Spedicato L, Simango LMC, Putoto G, Avogaro A, Fadini GP. Effectiveness of remote screening for diabetic retinopathy among patients referred to Mozambican Diabetes Association (AMODIA): a retrospective observational study. Acta Diabetol 2022; 59:563-569. [PMID: 35034184 PMCID: PMC8761102 DOI: 10.1007/s00592-021-01834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
AIMS Diabetes represents a growing public health problem in sub-Saharan Africa, where diabetic retinopathy (DR) is a major cause of permanent visual loss. We reported the results of a remote screening of DR among urbanized Mozambican people with diabetes. METHODS We retrospectively collected retinal images and clinical characteristics from 536 patients screened for DR in Maputo (Mozambique), over a period of 2 years (2018-2019). Retinal photographs were captured, digitally stored, and scored locally and by an expert ophthalmologist in Italy remotely. RESULTS The overall prevalence of DR was 29% with sight-threatening forms accounting for 8.1% of that number. Inter-reader agreement between the local and the Italian ophthalmologists was poor (k < 0.2). Patients with DR were older, had a longer duration of disease, worse glycaemic control, and a higher prevalence of comorbidities. In the multivariate logistic regression analysis, HbA1c, diabetes duration, and coronary heart disease (CHD) were associated with DR. CONCLUSION Prevalence of DR among urbanized Mozambican patients was similar to that observed in Western countries. Telediagnosis might partially overcome the paucity of local ophthalmologists with experience in DR.
Collapse
Affiliation(s)
- Mauro Rigato
- Department of Medicine, Diabetology Service, Azienda ULSS 2 Marca Trevigiana, 31100, Treviso, Italy.
| | - Laura Nollino
- Department of Medicine, Diabetology Service, Azienda ULSS 2 Marca Trevigiana, 31100, Treviso, Italy
| | - Armindo Tiago
- Faculty of Medicine, Ministry of Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Luigi Spedicato
- Department of Specialistic Surgery, Ophthalmology Service, Azienda ULSS 2 Marca Trevigiana, 31100, Treviso, Italy
| | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, 35128, Padova, Italy
| | | |
Collapse
|
33
|
Romero-Aroca P, Verges R, Maarof N, Vallas-Mateu A, Latorre A, Moreno-Ribas A, Sagarra-Alamo R, Basora-Gallisa J, Cristiano J, Baget-Bernaldiz M. Real-world outcomes of a clinical decision support system for diabetic retinopathy in Spain. BMJ Open Ophthalmol 2022; 7:e000974. [PMID: 35415265 PMCID: PMC8961111 DOI: 10.1136/bmjophth-2022-000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe aim of present study was to evaluate our clinical decision support system (CDSS) for predicting risk of diabetic retinopathy (DR). We selected randomly a real population of patients with type 2 diabetes (T2DM) who were attending our screening programme.Methods and analysisThe sample size was 602 patients with T2DM randomly selected from those who attended the DR screening programme. The algorithm developed uses nine risk factors: current age, sex, body mass index (BMI), duration and treatment of diabetes mellitus (DM), arterial hypertension, Glicated hemoglobine (HbA1c), urine–albumin ratio and glomerular filtration.ResultsThe mean current age of 67.03±10.91, and 272 were male (53.2%), and DM duration was 10.12±6.4 years, 222 had DR (35.8%). The CDSS was employed for 1 year. The prediction algorithm that the CDSS uses included nine risk factors: current age, sex, BMI, DM duration and treatment, arterial hypertension, HbA1c, urine–albumin ratio and glomerular filtration. The area under the curve (AUC) for predicting the presence of any DR achieved a value of 0.9884, the sensitivity of 98.21%, specificity of 99.21%, positive predictive value of 98.65%, negative predictive value of 98.95%, α error of 0.0079 and β error of 0.0179.ConclusionOur CDSS for predicting DR was successful when applied to a real population.
Collapse
Affiliation(s)
- Pedro Romero-Aroca
- Ophtalmology, Universitat Rovira i Virgili, Tarragona, Spain
- Ophthalmology, Hospital Universitario Sant Joan de Reus, Reus, Spain
- Ophthalmologhy, Institut de Investigacions Sanitaries Pere Virgili, Tarragona, Spain
| | - Raquel Verges
- Ophthalmology, Hospital Universitario Sant Joan de Reus, Reus, Spain
| | - Najlaa Maarof
- Department of Computer Engineering and Mathematics, Universitat Rovira i Virgili, Tarragona, Spain
| | - Aida Vallas-Mateu
- Mathematics, Universitat Rovira i Virgili Escola Tecnica Superior Enginyeria, Tarragona, Catalunya, Spain
| | - Alex Latorre
- Informatics, Hospital Universitario Sant Joan de Reus, Reus, Catalunya, Spain
| | - Antonio Moreno-Ribas
- Mathematics, Universitat Rovira i Virgili Escola Tecnica Superior Enginyeria, Tarragona, Catalunya, Spain
| | | | | | | | | |
Collapse
|
34
|
Alamri A, Al-Jahash NAS, Alsultan MSH, AlQahtani SSA, Saeed YAA, Alhamlan RAO. Awareness, knowledge, and practice regarding to diabetic retinopathy among KKU students besides medical students in Abha, Saudi Arabia. J Family Med Prim Care 2021; 10:3233-3239. [PMID: 34760736 PMCID: PMC8565152 DOI: 10.4103/jfmpc.jfmpc_86_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Diabetes mellitus (DM) is a global public health problem. Global prevalence of diabetes is 8.5% in adult population. The prevalence of diabetic retinopathy (DR) is increasing day by day, the number of persons with diabetes will double by 2030. It is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. This study's intent to estimate and improve level of awareness (A), knowledge (K), and practice (P) among all King Khalid University (KKU) students besides medical students in Abha, Saudi Arabia. Methods and Materials: This is a cross-sectional survey that targets all KKU students besides medical students in Abha, Saudi Arabia. The researchers will use closed-end questions for awareness (A), knowledge (K), and practice (P). The data and the questionnaires will be sent to the sample by social media. The data will be analyzed by statistical package for the social sciences program (SPSS). Results: A total of 635 KKU students completed the questionnaire. Female students were more than male students, 334 (52.6%) for females and 301 (47.4%) for males, respectively. Ages ranged from 18 to 24 years with a mean 23 ± 2 years. There was a good awareness for some of the factors related to the DR which is noted in the results. Awareness of smoking and pregnancy rate is extremely low compared to the rest of the factors related to the DR. Conclusion: There was high awareness regarding DR and its risk factors among KKU students but low awareness regarding smoking and pregnancy relationship with DR. Improvement is required for smoking and pregnancy with the progression DR.
Collapse
Affiliation(s)
- Abdulrahman Alamri
- Department Ophthalmology College of Medicine, King Khalid University, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
35
|
Riordan F, Murphy A, Dillon C, Browne J, Kearney PM, Smith SM, McHugh SM. Feasibility of a multifaceted implementation intervention to improve attendance at diabetic retinopathy screening in primary care in Ireland: a cluster randomised pilot trial. BMJ Open 2021; 11:e051951. [PMID: 34667010 PMCID: PMC8527153 DOI: 10.1136/bmjopen-2021-051951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Diabetic retinopathy screening (DRS) uptake is suboptimal in many countries with limited evidence available on interventions to enhance DRS uptake in primary care. We investigated the feasibility and preliminary effects of an intervention to improve uptake of Ireland's national DRS programme, Diabetic RetinaScreen, among patients with type 1 or type 2 diabetes. DESIGN/SETTING We conducted a cluster randomised pilot trial, embedded process evaluation and cost analysis in general practice, July 2019 to January 2020. PARTICIPANTS Eight practices participated in the trial. For the process evaluation, surveys were conducted with 25 staff at intervention practices. Interviews were conducted with nine staff at intervention practices, and 10 patients who received the intervention. INTERVENTIONS The intervention comprised practice reimbursement, an audit of attendance, electronic prompts targeting professionals, General Practice-endorsed patient reminders and a patient information leaflet. Practices were randomly allocated to intervention (n=4) or wait-list control (n=4) (usual care). OUTCOMES Staff and patient interviews explored their perspectives on the intervention. Patient registration and attendance, including intention to attend, were measured at baseline and 6 months. Microcosting was used to estimate intervention delivery cost. RESULTS The process evaluation identified that enablers of feasibility included practice culture and capacity to protect time, systems to organise care, and staff skills, and workarounds to improve intervention 'fit'. At 6 months, 22/71 (31%) of baseline non-attenders in intervention practices subsequently attended screening compared with 15/87 (17%) in control practices. The total delivery cost across intervention practices (patients=363) was €2509, averaging €627 per practice and €6.91 per audited patient. Continuation criteria supported proceeding to a definitive trial. CONCLUSIONS The Improving Diabetes Eye screening Attendance intervention is feasible in primary care; however, consideration should be given to how best to facilitate local tailoring. A definitive trial of clinical and cost-effectiveness is required with preliminary results suggesting a positive effect on uptake. TRIAL REGISTRATION NUMBER NCT03901898.
Collapse
Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | | | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
36
|
Amer J, Suboh R, Abualrob M, Shaheen A, Abu Shanab AR. Risk Factors Associated With Diabetic Retinopathy: A Cross-Sectional Study Within Palestinian Patients in Northern West Bank. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:736715. [PMID: 36994348 PMCID: PMC10012083 DOI: 10.3389/fcdhc.2021.736715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022]
Abstract
Risk factors associated with diabetes mellitus (DM) have been widely researched worldwide, but the determinants of these factors among diabetic retinopathy (DR) in Palestine are currently unclear. We aimed to assess the prevalence of DR among DM in Northern West Bank and identify factors associated with DR natural history. Patients with Type 2 diabetes (T2D) (n = 300, age > 18 years) from a main diabetic center covering all northern provinces of Palestine were enrolled to this cross-sectional research. Demographic information including age, sex, and duration of T2D was obtained. Moreover, HbA1C, BMI, hypertension (HTN), controlled T2D, current smoking, and total cholesterol level were assessed. Potential correlations between these factors and DR diagnosed by ophthalmologist were evaluated using different tests on SPSS version 22. Prevalence of DR among our population was 30%; 47.8% of these patients showed mild non-proliferative DR (NPDR), 23.3% moderate NPDR, 16.7% severe NPDR, and 12.2% proliferative DR (PDR). Univariate logistic regression analysis showed age (p = 0.007), HTN (p = 0.022), uncontrolled T2D (p = 0.025), and duration of T2D (<0.001) were mostly associated with DR while multivariate logistic regression showed duration of T2D as the major and solely risk factor for prevalence of DR (p < 0.0001) and were positively correlated with severities of NPDR and being a strong predictor in the PDR (p = 0.001). We identified several important risk factors that affect DR, which could assist to develop effective strategies for metabolic disease prevention among populations in Palestine. Furthermore, our data suggest a necessity to control sugar serum levels and HTN.
Collapse
Affiliation(s)
- Johnny Amer
- Physiology, Pharmacology & Toxicology Division, An-Najah National University, Nablus, Palestine
- *Correspondence: Johnny Amer,
| | - Raghad Suboh
- Physiology, Pharmacology & Toxicology Division, An-Najah National University, Nablus, Palestine
| | - Manar Abualrob
- Physiology, Pharmacology & Toxicology Division, An-Najah National University, Nablus, Palestine
| | - Amira Shaheen
- Division of Public Health, Department of Biomedical Sciences, An-Najah National University, Nablus, Palestine
| | - Abdul Raheem Abu Shanab
- Department of Applied and Allied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|
37
|
Kanclerz P, Tuuminen R, Khoramnia R. Imaging Modalities Employed in Diabetic Retinopathy Screening: A Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:1802. [PMID: 34679501 PMCID: PMC8535170 DOI: 10.3390/diagnostics11101802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Urbanization has caused dramatic changes in lifestyle, and these rapid transitions have led to an increased risk of noncommunicable diseases, such as type 2 diabetes. In terms of cost-effectiveness, screening for diabetic retinopathy is a critical aspect in diabetes management. The aim of this study was to review the imaging modalities employed for retinal examination in diabetic retinopathy screening. METHODS The PubMed and Web of Science databases were the main sources used to investigate the medical literature. An extensive search was performed to identify relevant articles concerning "imaging", "diabetic retinopathy" and "screening" up to 1 June 2021. Imaging techniques were divided into the following: (i) mydriatic fundus photography, (ii) non-mydriatic fundus photography, (iii) smartphone-based imaging, and (iv) ultrawide-field imaging. A meta-analysis was performed to analyze the performance and technical failure rate of each method. RESULTS The technical failure rates for mydriatic and non-mydriatic digital fundus photography, smartphone-based and ultrawide-field imaging were 3.4% (95% CI: 2.3-4.6%), 12.1% (95% CI: 5.4-18.7%), 5.3% (95% CI: 1.5-9.0%) and 2.2% (95% CI: 0.3-4.0%), respectively. The rate was significantly different between all analyzed techniques (p < 0.001), and the overall failure rate was 6.6% (4.9-8.3%; I2 = 97.2%). The publication bias factor for smartphone-based imaging was significantly higher than for mydriatic digital fundus photography and non-mydriatic digital fundus photography (b = -8.61, b = -2.59 and b = -7.03, respectively; p < 0.001). Ultrawide-field imaging studies were excluded from the final sensitivity/specificity analysis, as the total number of patients included was too small. CONCLUSIONS Regardless of the type of the device used, retinal photographs should be taken on eyes with dilated pupils, unless contraindicated, as this setting decreases the rate of ungradable images. Smartphone-based and ultrawide-field imaging may become potential alternative methods for optimized DR screening; however, there is not yet enough evidence for these techniques to displace mydriatic fundus photography.
Collapse
Affiliation(s)
- Piotr Kanclerz
- Hygeia Clinic, 80-286 Gdańsk, Poland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Eye Centre, Kymenlaakso Central Hospital, 48100 Kotka, Finland
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany;
| |
Collapse
|
38
|
Lian JX, McGhee SM, So C, Kwong ASK, Sum R, Tsui WWS, Chao DVK, Chan JCH. Screening for diabetic retinopathy with different levels of financial incentive in a randomized controlled trial. J Diabetes Investig 2021; 12:1632-1641. [PMID: 33484625 PMCID: PMC8409893 DOI: 10.1111/jdi.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION To examine the impact of different levels of financial incentive in terms of fee subsidization on diabetic retinopathy screening in the private primary care setting in Hong Kong. MATERIALS AND METHODS All general practitioners working in the private sector and registered in two electronic public databases were invited to participate. Consecutive patients with diabetes mellitus were then recruited by the participating practitioners. The recruited participants were randomly allocated to one of three screening groups with different fee levels (HK$0, HK$150 [US$19], HK$300 [US$39]) in a randomized controlled trial. Screening uptake and severity of diabetic retinopathy detected were compared. RESULTS Out of 1,688 eligible practitioners, 105 participated and invited 402 patients, with 239 initially agreeing to participate (59.5%). After randomization, 78, 75 and 76 participants in the HK$0, HK$150 and HK$300 fee groups, respectively, reconfirmed their participation and were offered screening at the relevant fee. The uptake of screening was 79.5% (62/78), 81.3% (61/75) and 63.2% (48/76), in the HK$0, HK$150 and HK$300 groups, respectively (P < 0.018). Being in the HK$150 fee group was associated with higher uptake of screening than being in the HK$300 fee group (odds ratio 2.31, P = 0.039). No significant difference was found in the prevalence of any diabetic retinopathy (33.9%, 27.9% and 37.5%, P = 0.378) or sight-threatening diabetic retinopathy (4.8%, 8.2% and 16.7%; P = 0.092) among the groups. CONCLUSION A screening fee of HK$150, representing approximately a half subsidy, appears to be as effective in maximizing uptake as a full subsidy (HK$0) and without deterring those at high risk of diabetic retinopathy from screening.
Collapse
Affiliation(s)
- Jin Xiao Lian
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | | | - Ching So
- Department of OphthalmologyThe University of Hong KongHong KongHong Kong
| | - Alfred Siu Kei Kwong
- Department of Family Medicine and Primary Health CareHong Kong West ClusterHong Kong Hospital AuthorityHong Kong IslandHong Kong
| | - Rita Sum
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | - Wendy Wing Sze Tsui
- Department of Family Medicine and Primary Health CareHong Kong West ClusterHong Kong Hospital AuthorityHong Kong IslandHong Kong
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health CareKowloon East ClusterHong Kong Hospital AuthorityHong Kong IslandHong Kong
| | | |
Collapse
|
39
|
Wintergerst MWM, Bejan V, Hartmann V, Schnorrenberg M, Bleckwenn M, Weckbecker K, Finger RP. Telemedical Diabetic Retinopathy Screening in a Primary Care Setting: Quality of Retinal Photographs and Accuracy of Automated Image Analysis. Ophthalmic Epidemiol 2021; 29:286-295. [PMID: 34151725 DOI: 10.1080/09286586.2021.1939886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Screening for diabetic eye disease (DED) and general diabetes care is often separate, which leads to delays and low adherence to DED screening recommendations. Thus, we assessed the feasibility, achieved image quality, and possible barriers of telemedical DED screening in a point-of-care general practice setting and the accuracy of an automated algorithm for detection of DED.Methods: Patients with diabetes were recruited at general practices. Retinal images were acquired using a non-mydriatic camera (CenterVue, Italy) by medical assistants. Images were quality assessed and double graded by two graders. All images were also graded automatically using a commercially available artificial intelligence (AI) algorithm (EyeArt version 2.1.0, Eyenuk Inc.).Results: A total of 75 patients (147 eyes; mean age 69 years, 96% type 2 diabetes) were included. Most of the patients (51; 68%) preferred DED screening at the general practice, but only twenty-four (32%) were willing to pay for this service. Images of 63 patients (84%) were determined to be evaluable, and DED was diagnosed in 6 patients (8.0%). The algorithm's positive/negative predictive values (95% confidence interval) were 0.80 (0.28-0.99)/1.00 (0.92-1.00) and 0.75 (0.19-0.99)/0.98 (0.88-1.00) for detection of any DED and referral-warranted DED, respectively.Overall, the number of referrals was 18 (24%) for manual telemedical assessment and 31 (41%) for the artificial intelligence (AI) algorithm, resulting in a relative increase of referrals by 72% when using AI.Conclusions: Our study shows that achieved overall image quality in a telemedical GP-based DED screening was sufficient and that it would be accepted by medical assistants and patients in most cases. However, good image quality and integration into existing workflow remain challenging. Based on these findings, a larger-scale implementation study is warranted.
Collapse
Affiliation(s)
| | - Veronica Bejan
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Vera Hartmann
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Marina Schnorrenberg
- Institute of General Practice and Interprofessional Care, Faculty of Health/Department of Medicine, University Witten/Herdecke, Witten, Germany
| | - Markus Bleckwenn
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Interprofessional Care, Faculty of Health/Department of Medicine, University Witten/Herdecke, Witten, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
40
|
Roser P, Grohmann C, Aberle J, Spitzer MS, Kromer R. Evaluation der Implementierung eines zugelassenen Künstliche-Intelligenz-Systems zur Erkennung der diabetischen Retinopathie. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1484-9678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Einleitung Ziel der Studie war die Evaluation der Genauigkeit einer auf einem Künstliche-Intelligenz-System (KI) basierenden Bewertung von Fundusfotografien im Vergleich zum Augenarzt in Bezug auf das diabetische Retinopathie-Screening in einer internistisch geführten Klinik. Zudem erfolgte die Erhebung der Gesamtuntersuchungsdauer wie auch der Patienten- und Untersucherzufriedenheit.
Methoden Im Rahmen der Studie erhielten 112 ambulante Patienten eine Fundusfotografie mit automatisierter Diagnose der diabetischen Retinopathie (DR) über das IDx-DR-System (Digital Diagnostics). Die Aufnahmen erfolgten mit der Kamera Topcon TRC-NW400 (Topcon Corp. Japan). Einschlusskriterium war die Diagnose eines Diabetes mellitus Typ 1, 2 oder 3. Bei Patienten, bei denen keine Aufnahme mit ausreichender Qualität in Miosis durchgeführt werden konnte, erfolgte die Aufnahme in Mydriasis.
Ergebnisse Von 112 Patienten konnte bei 107 Patienten (95,5 %) durch das Grading mittels IDx-DR, anhand der Fundusaufnahmen, eine Analyse durchgeführt werden – vs. bei 103 Patienten (91,9 %) durch das Grading derselben, hochauflösenden Fundusaufnahmen durch Augenärzte. Bei den verbleibenden Patienten war eine Beurteilung allein durch die Funduskopie in Mydriasis möglich. Es zeigte sich eine hochsignifikante Korrelation bezüglich der Einschätzung der Schwere der diabetischen Retinopathie zwischen Untersucher und dem IDx-DR-System (Correlation coefficient (r) = 0,8738; p < 0,0001). Die Patientenzufriedenheit lag bei 4,5 ± 0,6 [1–5], die Gesamtdauer der Untersuchung in Miosis lag im Mittel bei 3:04 ± 0:28 [min:sek].
Schlussfolgerung Das Retinopathiescreening mittels IDx-DR ermöglicht die automatisierte, zeitnahe und zuverlässige Beurteilung bzgl. des Vorliegens einer diabetischen Retinopathie mit einem robusten technischen und klinischen Arbeitsfluss, der mit einer hohen Patientenzufriedenheit einhergeht.
Collapse
Affiliation(s)
- Pia Roser
- Department of Nephrology, Rheumatology and Endocrinology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Grohmann
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Aberle
- Department of Nephrology, Rheumatology and Endocrinology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martin S. Spitzer
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Kromer
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
41
|
Kelly SR, Loiselle AR, Pandey R, Combes A, Murphy C, Kavanagh H, Fitzpatrick P, Mooney T, Kearney P, Crabb DP, Keegan DJ. Factors associated with non-attendance in the Irish national diabetic retinopathy screening programme (INDEAR study report no. 2). Acta Diabetol 2021; 58:643-650. [PMID: 33483856 PMCID: PMC8076137 DOI: 10.1007/s00592-021-01671-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023]
Abstract
AIMS We aimed to determine the patient and screening-level factors that are associated with non-attendance in the Irish National Diabetic Retinal screening programme (Diabetic RetinaScreen). To accomplish this, we modelled a selection of predictors derived from the historical screening records of patients with diabetes. METHODS In this cohort study, appointment data from the national diabetic retinopathy screening programme (RetinaScreen) were extracted and augmented using publicly available meteorological and geospatial data. A total of 653,969 appointments from 158,655 patients were included for analysis. Mixed-effects models (univariable and multivariable) were used to estimate the influence of several variables on non-attendance to screening appointments. RESULTS All variables considered for analysis were statistically significant. Variables of note, with meaningful effect, were age (OR: 1.23 per decade away from 70; 95% CI: [1.22-1.24]), type 2 diabetes (OR: 1.10; 95% CI: [1.06-1.14]) and socio-economic deprivation (OR: 1.12; 95% CI: [1.09-1.16]). A majority (52%) of missed appointments were from patients who had missed three or more appointments. CONCLUSIONS This study is the first to outline factors that are associated with non-attendance within the Irish national diabetic retinopathy screening service. In particular, when corrected for age and other factors, patients with type 2 diabetes had higher rates of non-attendance. Additionally, this is the first study of any diabetic screening programme to demonstrate that weather may influence attendance. This research provides unique insight to guide the implementation of an optimal and cost-effective intervention strategy to improve attendance.
Collapse
Affiliation(s)
- Stephen R Kelly
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Allison R Loiselle
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, Netherlands
| | - Rajiv Pandey
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Colette Murphy
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| | - Helen Kavanagh
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| | - Patricia Fitzpatrick
- Programme Evaluation Unit, National Screening Service, Health Service Executive, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Therese Mooney
- Programme Evaluation Unit, National Screening Service, Health Service Executive, Dublin, Ireland
| | - Patricia Kearney
- Department of Epidemiology, University College Cork, Cork, Ireland
| | - David P Crabb
- Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David J Keegan
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| |
Collapse
|
42
|
Nagasawa T, Tabuchi H, Masumoto H, Morita S, Niki M, Ohara Z, Yoshizumi Y, Mitamura Y. Accuracy of Diabetic Retinopathy Staging with a Deep Convolutional Neural Network Using Ultra-Wide-Field Fundus Ophthalmoscopy and Optical Coherence Tomography Angiography. J Ophthalmol 2021; 2021:6651175. [PMID: 33884202 PMCID: PMC8041547 DOI: 10.1155/2021/6651175] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/11/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The present study aimed to compare the accuracy of diabetic retinopathy (DR) staging with a deep convolutional neural network (DCNN) using two different types of fundus cameras and composite images. METHOD The study included 491 ultra-wide-field fundus ophthalmoscopy and optical coherence tomography angiography (OCTA) images that passed an image-quality review and were graded as no apparent DR (NDR; 169 images), mild nonproliferative DR (NPDR; 76 images), moderate NPDR (54 images), severe NPDR (90 images), and proliferative DR (PDR; 102 images) by three retinal experts by the International Clinical Diabetic Retinopathy Severity Scale. The findings of tests 1 and 2 to identify no apparent diabetic retinopathy (NDR) and PDR, respectively, were then assessed. For each verification, Optos, OCTA, and Optos OCTA imaging scans with DCNN were performed. RESULT The Optos, OCTA, and Optos OCTA imaging test results for comparison between NDR and DR showed mean areas under the curve (AUC) of 0.79, 0.883, and 0.847; sensitivity rates of 80.9%, 83.9%, and 78.6%; and specificity rates of 55%, 71.6%, and 69.8%, respectively. Meanwhile, the Optos, OCTA, and Optos OCTA imaging test results for comparison between NDR and PDR showed mean AUC of 0.981, 0.928, and 0.964; sensitivity rates of 90.2%, 74.5%, and 80.4%; and specificity rates of 97%, 97%, and 96.4%, respectively. CONCLUSION The combination of Optos and OCTA imaging with DCNN could detect DR at desirable levels of accuracy and may be useful in clinical practice and retinal screening. Although the combination of multiple imaging techniques might overcome their individual weaknesses and provide comprehensive imaging, artificial intelligence in classifying multimodal images has not always produced accurate results.
Collapse
Affiliation(s)
- Toshihiko Nagasawa
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University, Hiroshima 739-8511, Japan
| | - Hiroki Masumoto
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Shoji Morita
- Graduate School of Engineering, University of Hyogo, Kobe 657-0013, Japan
| | - Masanori Niki
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8851, Japan
| | - Zaigen Ohara
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Yuki Yoshizumi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8851, Japan
| |
Collapse
|
43
|
Ravindran M, Segi A, Mohideen S, Allapitchai F, Rengappa R. Impact of teleophthalmology during COVID-19 lockdown in a tertiary care center in South India. Indian J Ophthalmol 2021; 69:714-718. [PMID: 33595507 PMCID: PMC7942072 DOI: 10.4103/ijo.ijo_2935_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: The aim of this study was to describe the experience of teleconsultations addressed at our hospital in India during the ongoing coronavirus (COVID-19) lockdown. Methods: This cross-sectional hospital-based study included 977 teleconsultations presenting between April 1st and May 31, 2020. A two-level protocol was implemented to triage the calls. Results: Overall, 977 teleconsultation were addressed. Of the 621 teleconsultation addressed the most common queries were related to redness/pain/ watering/blurred vision/itching/irritation (52.49%), followed by queries related to medications (28.01%), appointments (18.84%) & 0.64% cited an emergency need to visit the hospital due to sudden loss of vision. The majority of the queries were directed to the department of cornea (58.93%) followed by retina (16.26%), cataract (13.04%), glaucoma (10.14%) & pediatric ophthalmology (1.61%). The most common advice given to the patient was related to medications (47.66%) followed by appointment-related queries (31.72%) & fixing of surgical appointment (20.61%). Among the 356 preterm babies that were screened, 57 (16.01%) were diagnosed with retinopathy of prematurity (ROP). Of them 3 required laser and 3 were given injection. Conclusion: Teleconsultation is here to stay beyond the pandemic. WhatsApp was the preferred modality of communication for us. Teleophthalmology has given us insights to use this evolving technology to reach out to the population at large to provide eye care services. We believe that this mode of teleophthalmology has helped us in providing feasible eye care to the patients.
Collapse
Affiliation(s)
- Meenakshi Ravindran
- Department of Paediatrics, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Ashwin Segi
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Syed Mohideen
- Department of Retina, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Fathima Allapitchai
- Department of Paediatrics, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Ramakrishna Rengappa
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| |
Collapse
|
44
|
Bascaran C, Mwangi N, D’Esposito F, Gordon I, Ulloa JAL, Mdala S, Ramke J, Evans JR, Burton M. Effectiveness of task-shifting for the detection of diabetic retinopathy in low- and middle-income countries: a rapid review protocol. Syst Rev 2021; 10:4. [PMID: 33390182 PMCID: PMC7780379 DOI: 10.1186/s13643-020-01553-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is the most common ocular complication of diabetes and a cause of vision loss in adults. Diabetic retinopathy screening leading to early identification of the disease followed by timely treatment, can prevent vision loss in people living with diabetes. A key barrier to the implementation of screening services in low- and middle-income countries is the low number of ophthalmologists per million population. Interventions that shift screening to non-ophthalmology cadres have been implemented in programmes in low- and middle-income countries and are routinely used in high-income countries. The aim of this rapid review is to summarise the published literature reporting the effectiveness of task-shifting interventions for the detection of diabetic retinopathy by non-ophthalmologists in low- and middle-income countries. METHODS We will search MEDLINE, Embase, Global Health and Cochrane Register of Studies for studies reporting task-shifting interventions for diabetic retinopathy detection. The review will include studies published in the last 10 years in the English language. We will include any interventional or observational comparative study measuring outcomes in terms of participation or access to diabetic retinopathy detection services (uptake) and quality of diabetic retinopathy detection services (detection, severity, diagnostic accuracy). For included studies, cost-effectiveness of the task-shifting intervention will also be presented. Two reviewers will screen search results independently. The risk of bias assessment and data extraction will be carried out by one reviewer with verification of 10% of the papers by a second reviewer. The results will be synthesised narratively. DISCUSSION Differences in health systems organization, structure and resources will determine the need and success of task-shifting interventions for DR screening. The review will examine how these interventions have been used and/or tested in LMICs. The results will be of interest to policy makers and programme managers tasked with designing and implementing services to prevent and manage diabetes and its complications in similar settings. SYSTEMATIC REVIEW REGISTRATION OSF: https://osf.io/dfhg6/ .
Collapse
Affiliation(s)
- Covadonga Bascaran
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nyawira Mwangi
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Kenya Medical Training College, Nairobi, Kenya
| | | | - Iris Gordon
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Shaffi Mdala
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Jacqueline Ramke
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Jennifer R. Evans
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Matthew Burton
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Moorfields Eye Hospital, London, UK
| |
Collapse
|
45
|
Broadbent DM, Wang A, Cheyne CP, James M, Lathe J, Stratton IM, Roberts J, Moitt T, Vora JP, Gabbay M, García-Fiñana M, Harding SP. Safety and cost-effectiveness of individualised screening for diabetic retinopathy: the ISDR open-label, equivalence RCT. Diabetologia 2021; 64:56-69. [PMID: 33146763 PMCID: PMC7716929 DOI: 10.1007/s00125-020-05313-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Using variable diabetic retinopathy screening intervals, informed by personal risk levels, offers improved engagement of people with diabetes and reallocation of resources to high-risk groups, while addressing the increasing prevalence of diabetes. However, safety data on extending screening intervals are minimal. The aim of this study was to evaluate the safety and cost-effectiveness of individualised, variable-interval, risk-based population screening compared with usual care, with wide-ranging input from individuals with diabetes. METHODS This was a two-arm, parallel-assignment, equivalence RCT (minimum 2 year follow-up) in individuals with diabetes aged 12 years or older registered with a single English screening programme. Participants were randomly allocated 1:1 at baseline to individualised screening at 6, 12 or 24 months for those at high, medium and low risk, respectively, as determined at each screening episode by a risk-calculation engine using local demographic, screening and clinical data, or to annual screening (control group). Screening staff and investigators were observer-masked to allocation and interval. Data were collected within the screening programme. The primary outcome was attendance (safety). A secondary safety outcome was the development of sight-threatening diabetic retinopathy. Cost-effectiveness was evaluated within a 2 year time horizon from National Health Service and societal perspectives. RESULTS A total of 4534 participants were randomised. After withdrawals, there were 2097 participants in the individualised screening arm and 2224 in the control arm. Attendance rates at first follow-up were equivalent between the two arms (individualised screening 83.6%; control arm 84.7%; difference -1.0 [95% CI -3.2, 1.2]), while sight-threatening diabetic retinopathy detection rates were non-inferior in the individualised screening arm (individualised screening 1.4%, control arm 1.7%; difference -0.3 [95% CI -1.1, 0.5]). Sensitivity analyses confirmed these findings. No important adverse events were observed. Mean differences in complete case quality-adjusted life-years (EuroQol Five-Dimension Questionnaire, Health Utilities Index Mark 3) did not significantly differ from zero; multiple imputation supported the dominance of individualised screening. Incremental cost savings per person with individualised screening were £17.34 (95% CI 17.02, 17.67) from the National Health Service perspective and £23.11 (95% CI 22.73, 23.53) from the societal perspective, representing a 21% reduction in overall programme costs. Overall, 43.2% fewer screening appointments were required in the individualised arm. CONCLUSIONS/INTERPRETATION Stakeholders involved in diabetes care can be reassured by this study, which is the largest ophthalmic RCT in diabetic retinopathy screening to date, that extended and individualised, variable-interval, risk-based screening is feasible and can be safely and cost-effectively introduced in established systematic programmes. Because of the 2 year time horizon of the trial and the long time frame of the disease, robust monitoring of attendance and retinopathy rates should be included in any future implementation. TRIAL REGISTRATION ISRCTN 87561257 FUNDING: The study was funded by the UK National Institute for Health Research. Graphical abstract.
Collapse
Affiliation(s)
- Deborah M Broadbent
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK.
- St Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK.
| | - Amu Wang
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | - Christopher P Cheyne
- Department of Biostatistics, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- Clinical Trials Research Centre, Liverpool, UK
| | - Marilyn James
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - James Lathe
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Irene M Stratton
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK
| | | | - Tracy Moitt
- Clinical Trials Research Centre, Liverpool, UK
| | - Jiten P Vora
- Department of Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool, UK
| | - Mark Gabbay
- Department of Health Services Research, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- Brownlow Health Centre, Member of Liverpool Health Partners, Liverpool, UK
| | - Marta García-Fiñana
- Department of Biostatistics, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- Clinical Trials Research Centre, Liverpool, UK
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | | |
Collapse
|
46
|
Eszes DJ, Szabó DJ, Russell G, Lengyel C, Várkonyi T, Paulik E, Nagymajtényi L, Facskó A, Petrovski G, Petrovski BÉ. Diabetic Retinopathy Screening in Patients with Diabetes Using a Handheld Fundus Camera: The Experience from the South-Eastern Region in Hungary. J Diabetes Res 2021; 2021:6646645. [PMID: 33628836 PMCID: PMC7884113 DOI: 10.1155/2021/6646645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/20/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients. METHODS A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded. RESULTS 787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening (HbA1c > 7% associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance). CONCLUSION The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs.
Collapse
Affiliation(s)
- Dóra Júlia Eszes
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Júlia Szabó
- Department of Ophthalmology, Szent-Györgyi Albert Clinical Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Greg Russell
- Eyenuk Inc., Clinical Development, Woodland Hills, CA, USA
| | - Csaba Lengyel
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Várkonyi
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Edit Paulik
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - László Nagymajtényi
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Facskó
- Department of Ophthalmology, Szent-Györgyi Albert Clinical Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Beáta Éva Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- The A. I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare the Russian Federation, Moscow, Russia
| |
Collapse
|
47
|
Heimann H, Broadbent D, Cheeseman R. Digital Ophthalmology in the UK - Diabetic Retinopathy Screening and Virtual Glaucoma Clinics in the National Health Service. Klin Monbl Augenheilkd 2020; 237:1400-1408. [PMID: 33285586 DOI: 10.1055/a-1300-7779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.
Collapse
Affiliation(s)
- Heinrich Heimann
- St. Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Deborah Broadbent
- St. Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Robert Cheeseman
- St. Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| |
Collapse
|
48
|
Wintergerst MW, Mishra DK, Hartmann L, Shah P, Konana VK, Sagar P, Berger M, Murali K, Holz FG, Shanmugam MP, Finger RP. Diabetic Retinopathy Screening Using Smartphone-Based Fundus Imaging in India. Ophthalmology 2020; 127:1529-1538. [DOI: 10.1016/j.ophtha.2020.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
|
49
|
Emamipour S, van der Heijden AAWA, Nijpels G, Elders P, Beulens JWJ, Postma MJ, van Boven JFM, Feenstra TL. A personalised screening strategy for diabetic retinopathy: a cost-effectiveness perspective. Diabetologia 2020; 63:2452-2461. [PMID: 32734441 PMCID: PMC7527375 DOI: 10.1007/s00125-020-05239-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/10/2020] [Indexed: 01/06/2023]
Abstract
AIMS/HYPOTHESIS In this study we examined the cost-effectiveness of three different screening strategies for diabetic retinopathy: using a personalised adaptive model, annual screening (fixed intervals), and the current Dutch guideline (stratified based on previous retinopathy grade). METHODS For each individual, optimal diabetic retinopathy screening intervals were determined, using a validated risk prediction model. Observational data (1998-2017) from the Hoorn Diabetes Care System cohort of people with type 2 diabetes were used (n = 5514). The missing values of retinopathy grades were imputed using two scenarios of slow and fast sight-threatening retinopathy (STR) progression. By comparing the model-based screening intervals to observed time to develop STR, the number of delayed STR diagnoses was determined. Costs were calculated using the healthcare perspective and the societal perspective. Finally, outcomes and costs were compared for the different screening strategies. RESULTS For the fast STR progression scenario, personalised screening resulted in 11.6% more delayed STR diagnoses and €11.4 less costs per patient compared to annual screening from a healthcare perspective. The personalised screening model performed better in terms of timely diagnosis of STR (8.8% less delayed STR diagnosis) but it was slightly more expensive (€1.8 per patient from a healthcare perspective) than the Dutch guideline strategy. CONCLUSIONS/INTERPRETATION The personalised diabetic retinopathy screening model is more cost-effective than the Dutch guideline screening strategy. Although the personalised screening strategy was less effective, in terms of timely diagnosis of STR patients, than annual screening, the number of delayed STR diagnoses is low and the cost saving is considerable. With around one million people with type 2 diabetes in the Netherlands, implementing this personalised model could save €11.4 million per year compared with annual screening, at the cost of 658 delayed STR diagnoses with a maximum delayed time to diagnosis of 48 months.
Collapse
Affiliation(s)
- Sajad Emamipour
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands.
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
| | - Petra Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Talitha L Feenstra
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| |
Collapse
|
50
|
Pearce E, Sivaprasad S. A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models. Clin Ophthalmol 2020; 14:3285-3296. [PMID: 33116380 PMCID: PMC7569040 DOI: 10.2147/opth.s267521] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes with a prevalence of ~35%, and is one of the leading causes of visual impairment in people of working age in most developed countries. The earliest stage of DR, non-proliferative DR (NPDR), may progress to sight-threatening DR (STDR). Thus, early detection of DR and active regular screening of patients with diabetes are necessary for earlier intervention to prevent sight loss. While some countries offer systematic DR screening, most nations are reliant on opportunistic screening or do not offer any screening owing to limited healthcare resources and infrastructure. Currently, retinal imaging approaches for DR screening include those with and without mydriasis, imaging in single or multiple fields, and the use of conventional or ultra-wide-field imaging. Advances in telescreening and automated detection facilitate screening in previously hard-to-reach communities. Despite the heterogeneity in approaches to fit local needs, an evidence base must be created for each model to inform practice. In this review, we appraise different aspects of DR screening, including technological advances, identify evidence gaps, and propose several studies to improve DR screening globally, with a view to identifying patients with moderate-to-severe NPDR who would benefit if a convenient treatment option to delay progression to STDR became available.
Collapse
Affiliation(s)
- Elizabeth Pearce
- Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK
| | - Sobha Sivaprasad
- Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK.,Medical Retina Department, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| |
Collapse
|