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Otis Bennett Walton, Jacob Gross, Alex Young, Kathryn Camero, Yvonne I Chu, Ricci Sanchez; Diabetic Retinopathy Teleretinal Screening: Computer Algorithm versus Reading Center. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1421.
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Use of diabetic teleretinal screening to assess for sight threatening diabetic eye disease (STDED) is increasingly common, but little research has been done to compare the screening effectiveness of computer automated interpretation to manual interpretation. We performed a retrospective chart review for diabetic patients who received diabetic teleretinal imaging, and computer algorithm results were compared with results from an image reading center of ophthalmologists and optometrists.
In order to increase screening rates among asymptomatic diabetics and direct patients with advanced disease to the eye clinics, Harris Health System (Houston, TX) patients received diabetic teleretinal screening in primary care clinics using non-mydriatic fundus photography. These images were analyzed by a computer algorithm, which classified patients into a binary referral or observation category. Each image was also reviewed by a trained optometrist or ophthalmologist, and the level of diabetic retinopathy was manually assigned. Results from 15,015 diabetic patients were evaluated. Additionally, a supplemental, retrospective chart review was performed for 384 patients determined by the reading center to have STDED, defined by a diagnosis of either severe non-proliferative DR or proliferative DR, so that the clinical result could be compared to both the computer based process and the reading center. Sensitivity and false negative rates were calculated.
Based upon the reading center diagnosis, the sensitivity of the algorithm in detecting STDED was 66.4% (95% confidence interval [CI] 62.8% - 69.9%), with a false negative rate of 2%. When compared to the clinical fundus exam cohort with STDED, the algorithm demonstrated 75% sensitivity (CI, 66.8% - 81.8%), with a false negative rate of 1%. The positive predictive value of the manual reading center in detecting clinically evident STDED was 62% (CI 55.4% - 68.4%).
In light of its low false negative rate, computer algorithm-based diabetic teleretinal screening may be an effective alternative to manual image interpretation in screening for one of the leading causes of preventable blindness.
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