September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Comparisons between an Optometrist (Optom), Trained Diabetic Retinal Screener/Grader (Grader) and Consultant Ophthalmologist (Consultant) assessments of Ultrawide field (UWF) images in Diabetic Retinopathy in a Teleophthalmology Setting.
Author Affiliations & Notes
  • Jae Jin Lee
    Ophthalmology, Croydon University Hospital, London, United Kingdom
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
  • Philip Alexander
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
    National Institute for Health Research Biomedical Research Centre, London, United Kingdom
  • Hussain Khambati
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
    National Institute for Health Research Biomedical Research Centre, London, United Kingdom
  • Mumina Khatun
    Ophthalmology, Croydon University Hospital, London, United Kingdom
    South West London Diabetic Eye Screening Programme , London, United Kingdom
  • Pearse A Keane
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
    National Institute for Health Research Biomedical Research Centre, London, United Kingdom
  • Catherine A Egan
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
    National Institute for Health Research Biomedical Research Centre, London, United Kingdom
  • Dawn Sim
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
    National Institute for Health Research Biomedical Research Centre, London, United Kingdom
  • Footnotes
    Commercial Relationships   Jae Jin Lee, None; Philip Alexander , None; Hussain Khambati, None; Mumina Khatun, None; Pearse Keane, Allergan (R), Bayer (R), Heidelberg (R), Novartis (R), Topcon (R); Catherine Egan, None; Dawn Sim, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6326. doi:
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      Jae Jin Lee, Philip Alexander, Hussain Khambati, Mumina Khatun, Pearse A Keane, Catherine A Egan, Dawn Sim; Comparisons between an Optometrist (Optom), Trained Diabetic Retinal Screener/Grader (Grader) and Consultant Ophthalmologist (Consultant) assessments of Ultrawide field (UWF) images in Diabetic Retinopathy in a Teleophthalmology Setting.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6326.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the agreement between optom, grader, and consultant assessments of UWF retinal images and clinical outcome of grading in a cohort of patients with established diabetic eye disease.

Methods : Patients attending a medical retina clinic with a diagnosis of diabetic eye disease were included. A single UWF image (Optos, plc, Dunfermine, Scotland, UK) centered on the posterior pole was included for both eyes. Retinopathy and maculopathy severity was graded according to United Kingdom National Screening Committee defined criteria. The presence of other retinal pathology was graded as present or absent, and outcomes of the virtual assessment were determined as; virtual follow-up within 1, 3, 6, or 12 months, or referral for a routine/urgent face-to-face consultation.

Results : 80 eyes of 40 patients were included. Kappa values for agreement were presented in the order of (1) consultant vs optom, (2) consultant vs grader, and (3) optom vs grader. Poor agreement was observed with retinopathy severity grading (Kappa= 0.26; 0.20; 0.30) which improved when retinopathy grades were risk stratified into two groups; none to moderate non-proliferative diabetic retinopathy (NPDR) and severe NPDR to PDR (kappa=0.72; 0.29; 0.43). There was good agreement with maculopathy grades (kappa=0.63; 0.48; 0.62) and for the detection of other retinal pathology (kappa=0.43; 0.72; 0.58). Outcome of the virtual assessment showed poor agreement (kappa=0.32; 0.32; 0.42) when divided into six possible outcomes and improved when reduced to two (virtual or face-to-face follow-up) (kappa=0.44; 0.46; 0.40). In the 11 cases where there was a difference in outcome grading, 3/11 (27%) were due to a disagreement regarding the activity of previously treated PDR, 5/11 (45.5%) presence of diabetic macular oedema, 3/11 (27%) a possible diagnosis of wet AMD.

Conclusions : This exploratory study examines the use of teleophthalmology for monitoring diabetic eye disease. We observed good agreement for the identification of treatable diabetic maculopathy, and simplified retinopathy grades. Outcome decisions showed fair agreement and differences were largely due a questionable presence of macular lesions. This may be improved by the addition of optical coherence tomography images.

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

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