September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Teleretinal Screening in Mexico: Automating Diabetic Retinopathy Screening at a Comprehensive Diabetes Care Clinic in Monterrey, Mexico
Author Affiliations & Notes
  • Gilberto Zamora
    VisionQuest Biomedical, LLC, Albuquerque, New Mexico, United States
  • Carla Agurto Rios
    VisionQuest Biomedical, LLC, Albuquerque, New Mexico, United States
  • Javier Lozano
    Clinicas del Azucar, Guadalupe, Mexico
  • Sheila C Nemeth
    VisionQuest Biomedical, LLC, Albuquerque, New Mexico, United States
  • Omar Meza
    Clinicas del Azucar, Guadalupe, Mexico
  • Eduardo Martinon
    Clinicas del Azucar, Guadalupe, Mexico
  • Jeremy Benson
    Computer Science, University of New Mexico, Albuquerque, New Mexico, United States
    VisionQuest Biomedical, LLC, Albuquerque, New Mexico, United States
  • Peter Soliz
    VisionQuest Biomedical, LLC, Albuquerque, New Mexico, United States
  • Footnotes
    Commercial Relationships   Gilberto Zamora, VisionQuest Biomedical LLC (E); Carla Agurto Rios, VisionQuest Biomedical LLC (E); Javier Lozano, Clinicas del Azucar (I); Sheila Nemeth, VisionQuest Biomedical LLC (E); Omar Meza, Clinicas del Azucar (E); Eduardo Martinon, Clinicas del Azucar (E); Jeremy Benson, University of New Mexico (F), VisionQuest Biomedical LLC (E); Peter Soliz, VisionQuest Biomedical LLC (I)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1583. doi:
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      Gilberto Zamora, Carla Agurto Rios, Javier Lozano, Sheila C Nemeth, Omar Meza, Eduardo Martinon, Jeremy Benson, Peter Soliz; Teleretinal Screening in Mexico: Automating Diabetic Retinopathy Screening at a Comprehensive Diabetes Care Clinic in Monterrey, Mexico. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1583.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : To present performance results of an automatic diabetic retinopathy screening software in data collected at a network of comprehensive diabetic care clinics in Monterrey, Mexico.

Methods : VisionQuest has developed the Diabetic Retinopathy Risk Analysis Computer Software (DR-RACS) to screen retinal images for the presence of diabetic retinopathy. DR-RACS processed retinal images collected at five clinics that are part of Clinicas del Azucar, Monterrey, Mexico, between February and July, 2015. DR-RACS generated a label for each case: “return in 12 months” for no DR or Mild NPDR, “return in 6 months” for moderate NPDR, “refer to ophthalmology” for severe NPDR or PDR, or “inadequate.” A case is composed of at least one image of the macula and one image of the optic disc from each eye. A case is inadequate if at least one eye does not have a macula centered image with sufficient quality due to small pupils, media opacities, or technical errors.
The images are part of a teleretinal screening system that uses Canon CR-2 non-mydriatic retinal cameras, a cloud-based PACS, and a remote reading center. Images are manually read within 48 hours according to the International Clinical Diabetic Retinopathy Grading Scale. Follow up with ophthalmology is arranged by the clinics.
Performance of the DR-RACS was measured against the ground truth of the readers.

Results : DR-RACS processed 1,203 cases of which 396 (33%) were rejected for low quality (half due to technical errors) with the results shown in Figure 1.
The sensitivity for detection of moderate NPDR was 81% and the specificity was 69%. The sensitivity for referral of severe NPDR cases or worse was 95%. For suspicion of CSME, DR-RACS labeled 32 of the 38 cases as “refer to ophthalmology” and six as “return in 6 months.”

Conclusions : The DR-RACS achieved clinically safe and effective performance for the detection of diabetic retinopathy in a clinical setting. Using DR-RACS would reduce reading workload by up to 54% and referrals to ophthalmology by almost 70%. Resource scarcity and limited access to care in places like Mexico make automation a viable alternative to screen their diabetic population.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Figure 1. DR-RACS results.

Figure 1. DR-RACS results.

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