Evaluation of an ophthalmic grader led virtual imaging clinic pathway in the management of patients with retina diseases.

Abstract

Purpose : To evaluate the diagnostic accuracy of a Retinal virtual multimodal-imaging clinic led by ophthalmic graders in the management of patients with retina diseases

Methods : Prospective comparative observational study. Patients who were known to have retinal diseases (including diabetic retinopathy (DR), age-related macular degeneration(AMD) or other retina conditions) were recruited from the Singapore National Eye Centre Retina Clinic, and underwent a clinical pathway, involving optical coherence tomography(OCT) [Cirrus Photo, Zeiss, Germany] and ultrawide wide field fundus image(UWF) [Clarus, Zeiss, Germany] which are reviewed by trained non-physician graders (Ophthalmic graders) to detect for active retinal disease that require treatment or further evaluation by ophthalmologist. Patients were subsequently reviewed on the same day in standard of care retina clinics by an ophthalmologist (resident to consultant level) blinded to the grader outcome with OCT performed as clinically indicated. The reference standard was evaluation of the clinical notes and multimodal imaging (OCT + UWF) by a masked Retina specialist. A composite outcome of active retinal disease was defined as the presence of either: 1)vision threatening diabetic retinopathy(VTDR) [severe non proliferative DR or active proliferative DR], 2) Centre involving diabetic macular edema, 3) Active neovascular AMD. The sensitivity and specificity of the new clinical pathway in identifying treatment requiring retinal disease was evaluated against the reference standard.

Results : There were 494 participants of which 38 (8.3%) patients had active retinal disease identified. The new clinical pathway had a sensitivity of 95.1 % (95% confidence interval [CI] 88.5-100%) and a specificity of 97.4% (95% CI 95.9-98.8%) to detect active retinal disease. The positive predictive value was 76.5% and the negative predictive value was 99.6% There were 2 cases of active retinal disease misclassified by the grader pathway as stable, and both had severe non-proliferative DR with no macular disease.

Conclusions : The new ophthalmic grader led multimodal imaging based clinical pathway had good sensitivity and specific for identifying active retinal disease that may require treatment. This pathway may be able to replace standard specialist outpatient clinic for the management of selected patients with retinal diseases.

This is a 2021 ARVO Annual Meeting abstract.