RESUMEN
INTRODUCTION: We compared the agreement of diabetic retinopathy (DR) assessment between trained non-physician graders (NPGs) and family physicians (FPs) in a primary healthcare setting. METHODS: This was a cross-sectional study conducted retrospectively over a period of one month. The participants were diabetic patients from two primary healthcare clinics (polyclinics) in Singapore. Single-field digital retinal images were obtained using a non-mydriatic 45-degree fundus camera. Retinal images were graded for the presence or absence of DR by FPs at the polyclinics and by NPGs at a central ocular grading centre. The FPs' and NPGs' assessments of DR were compared with readings by a single retinal specialist (reference standard). RESULTS: A total of 367 diabetic patients (706 eyes) were included in the study. The mean age of the patients was 63 years, and the majority were Chinese (83.8%). For DR assessment, the agreement between NPGs and the retinal specialist was substantial (ĸ = 0.66), while the agreement between FPs and the retinal specialist was only fair (ĸ = 0.40). NPGs' assessment showed higher sensitivity (70% vs. 45%) and comparable specificity (94% vs. 92%) as compared to FPs' assessment. The area under the receiver operating characteristic curve of NPGs' assessment of DR was greater than that of the FPs' (0.82 vs. 0.69, p < 0.001). CONCLUSION: This study has demonstrated that trained NPGs are able to provide good detection of DR and maculopathy from fundus photographs. Our findings suggest that DR screening by trained NPGs may provide a costeffective alternative to FPs.
Asunto(s)
Retinopatía Diabética/diagnóstico , Atención Primaria de Salud/métodos , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Midriáticos , Enfermeras y Enfermeros , Variaciones Dependientes del Observador , Oftalmología , Médicos de Familia , Curva ROC , Derivación y Consulta , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Singapur , Recursos HumanosRESUMEN
OBJECTIVE: To describe a new computer-assisted method to measure retinal vascular caliber over an extended area of the fundus. METHODS: Retinal photographs taken from participants of the Singapore Malay Eye Study (n = 3280) were used for this study. Retinal vascular caliber was measured and summarized as central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) using a new semi-automated computer-based program. Measurements were made at the Standard zone (from 0.5 to 1.0 disk diameter) and an Extended zone (from 0.5 to 2.0 disk diameter). RESULTS: Reliability of retinal vascular caliber measurement was high for the new Extended zone (intraclass correlation coefficients >0.90). Associations of CRAE with blood pressure were identical between the Extended and Standard zones (linear regression coefficient -2.53 vs. -2.61, z-test between the two measurements, p = 0.394). Associations of CRAE and CRVE with other cardiovascular risk factors were similar between measurements in the two zones. The R² of regression models for the Extended zone was slightly higher than that for the Standard zone for both CRAE (R², 0.324 vs. 0.288) and CRVE (R², 0.325 vs. 0.265). CONCLUSIONS: The new measures from Extended zone are comparable with the previous measures, and also more representative of retinal vascular caliber.