A short online course successfully trains non-ophthalmic diabetic retinopathy graders to recognize glaucomatous optic nerves in low-resource settings

Abstract

Purpose : Recent evidence (Tang J et al Lancet Glob Health 2019) suggests that glaucoma screening may be cost-effective in developing countries although it is generally not in high income countries. Screening of two major blinding eye diseases (glaucoma and diabetic retinopathy (DR) using the same resources is likely to further improve cost-effectiveness. The aim of this study was to test the efficacy of a one-week online course in training non-ophthalmic DR graders to recognize glaucomatous optic nerves in Vietnam.
Main Research Question: Can non-ophthalmic DR graders be trained inexpensively to accurately screen for glaucoma?

Methods : In this uncontrolled, interventional before-and-after study, 43 non-ophthalmic DR graders participating in an NGO program (primarily nurses and internists) took part in a self-taught, one-week online course on recognizing glaucomatous optic nerves. Their performance (% of images graded correctly as to ‘refer/no refer and ‘reason for referral’ compared to a panel of glaucoma specialists) on a test set of optic nerve photos from the GONE website, population studies and patients taking part in the DR screening program was assessed before and after training, and was compared with 29 local, non-glaucoma-specialist ophthalmologists not taking the course.

Intervention: Self-paced participation in an online course describing various aspects of a glaucomatous optic nerve over one week.

Results : The mean±SD age of the non-ophthalmic graders was 32.3±7.3 years, with a mean±SD working experience of 8.2±7.1 years, compared to 32.6±5.5 and 7.2±5.2 years years for ophthalmologists. Non-ophthalmic graders’ test performance improved from a mean of 33.3±14.3% pre-training to 55.8±12.6% post-training (P<0.0001). Their post-test performance did not differ from that of ophthalmologists (58.7±15.4%, p=0.384). Results (significant improvement with training, no difference between post training graders and ophthalmologists) were consistent regardless of the origin of the optic nerve images (GONE website, population study, local images from the Vietnam program).

Conclusions : Non-ophthalmic graders could significantly improve their accuracy in detecting glaucoma after a brief online course, and had performance comparable to ophthalmologists. This model could contribute to low-cost glaucoma screening in underserved settings.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.