Abstract
Purpose :
It is common for diabetic patients to go undiagnosed for diabetic retinopathy (DR) in earlier stages of disease. Patients tend to decline the dilated fundus exam due to the visual inconveniences. Teleretinal screening can help in early detection in primary care environments without the need for dilation. For teleretinal screening to be successful, the retinal screener should be simple enough for any non-ophthalmic personnel to capture clinically acceptable images. In this pilot study we compare the image quality captured on a retinal screener by a non-experienced operator with an experienced operator.
Methods :
A range of 12 undilated eyes from 7 subjects, (2 subjects diseased, 5 subjects healthy) were captured on the VELARA™ 200 (ZEISS, Dublin, CA) camera by an experienced user and a non-experienced user. The non-experienced user underwent a 10-minute training session before starting the study. Both users imaged the subjects and followed the step by step capture workflow provided by the system. The image quality was then graded by an optometrist on a 1-5 scale: 1–very poor, clinically unacceptable, 2–poor, clinically unacceptable, 3–fair, clinically acceptable, 4–good, clinically acceptable and, 5–excellent, clinically acceptable.
Results :
Out of the total 12 images each captured by both users, 11 images captured by the experienced user were graded as clinically acceptable and 10 images captured by the non-experienced user were graded as clinically acceptable. Figure 1 shows examples of clinically acceptable and unacceptable images captured by both users. The mean and standard deviation of image quality captured by the experienced user and non-experienced user were 3.4±0.6 and 3.3±0.9 respectively.
Conclusions :
Results from this pilot study suggest that a non-experienced user was able to get similar image quality compared to the experienced user. Future studies need to be performed in the primary care environment with a diverse diseased population and more operators to understand the effectiveness. This may be an effective way to do teleretinal screening in primary care in undilated eyes.The screener is not a replacement for a dilated eye exam as the retinal periphery is not captured. However, this may be an effective way to screen for early stages of DR and increase ophthalmic referrals to minimize the progression of DR.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.