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Researchers at the Joslin Diabetes Center reported that trained lay imagers were highly accurate in assessing ultra-widefield (UWF) images for the presence or absence of diabetic retinopathy (DR) and for referable DR at the diabetes clinic point of care (POC).1
Training and findings. The imagers had no prior experience in retinal image evaluation. They received 4 hours of lectures and 12 hours of guided image review in an established teleophthalmology program. Their work compared favorably with that performed by a centralized reading center.
In the study of nearly 4,000 eyes, the sensitivity and negative predictive value approached 1.00. Evaluators missed only 3 patients with referable DR and missed finding DR in 43 (1.1%) eyes.
“Our study demonstrates that appropriately trained and certified imagers following a defined image and grading protocol can accurately evaluate ultrawidefield retinal images,” said Paolo S. Silva, MD, staff ophthalmologist and assistant chief of telemedicine, at Joslin’s Beetham Eye Institute.
Benefits and barriers. The researchers estimate that use of such imagers for POC triage of UWF views could reduce the patient load at the centralized reading center by about 60%. Such efficiencies are increasingly important, given the rapid growth in the diabetic population worldwide.
Current barriers to widespread implementation of this approach include costs of the device as well as training and ongoing oversight of the imagers. However, the benefits, such as shorter evaluation time and improved grading rates, may outweigh the cost, Dr. Silva said.
—Miriam Karmel
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1 Silva PS et al. Diabetes Care. June 1, 2015 [Epub ahead of print].
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Relevant financial disclosures—Dr. Silva: Center of Integration of Medicine and Innovative Technology: S.
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