A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy

Jim Olson, F. M. Strachan, J. H. Hipwell, Keith A Goatman, K. C. McHardy, John Vincent Forrester, Peter Frederick Sharp

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme.

Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed.

Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52-88) and a specificity of 90% (87-93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82-98) and a specificity of 87% (84-90), and for colour slides, a sensitivity of 96% (87-100) and a specificity of 89% (86-91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77-89) and a specificity of 71% (66-75) and diabetic macular oedema with a sensitivity of 76% (53-92) and a specificity of 85% (82-88).

Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.

Original languageEnglish
Pages (from-to)528-534
Number of pages6
JournalDiabetic Medicine
Volume20
Issue number7
DOIs
Publication statusPublished - 2003

Keywords

  • diabetic retinopathy
  • screening
  • digital
  • colour slide
  • optometrist
  • automated
  • AUTOMATED DETECTION
  • EYE DISEASE
  • FLUORESCEIN ANGIOGRAMS
  • BLINDNESS
  • MICROANEURYSMS
  • QUANTIFICATION
  • POPULATION
  • FUNDUS
  • SYSTEM
  • TOOL

Cite this

Olson, J., Strachan, F. M., Hipwell, J. H., Goatman, K. A., McHardy, K. C., Forrester, J. V., & Sharp, P. F. (2003). A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. Diabetic Medicine, 20(7), 528-534. https://doi.org/10.1046/j.1464-5491.2003.00969.x

A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. / Olson, Jim; Strachan, F. M.; Hipwell, J. H.; Goatman, Keith A; McHardy, K. C.; Forrester, John Vincent; Sharp, Peter Frederick.

In: Diabetic Medicine, Vol. 20, No. 7, 2003, p. 528-534.

Research output: Contribution to journalArticle

Olson, J, Strachan, FM, Hipwell, JH, Goatman, KA, McHardy, KC, Forrester, JV & Sharp, PF 2003, 'A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy', Diabetic Medicine, vol. 20, no. 7, pp. 528-534. https://doi.org/10.1046/j.1464-5491.2003.00969.x
Olson, Jim ; Strachan, F. M. ; Hipwell, J. H. ; Goatman, Keith A ; McHardy, K. C. ; Forrester, John Vincent ; Sharp, Peter Frederick. / A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. In: Diabetic Medicine. 2003 ; Vol. 20, No. 7. pp. 528-534.
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abstract = "Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme.Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed.Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73{\%} (52-88) and a specificity of 90{\%} (87-93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93{\%} (82-98) and a specificity of 87{\%} (84-90), and for colour slides, a sensitivity of 96{\%} (87-100) and a specificity of 89{\%} (86-91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4{\%} of patients) than colour slide photography (11.9{\%}). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83{\%} (77-89) and a specificity of 71{\%} (66-75) and diabetic macular oedema with a sensitivity of 76{\%} (53-92) and a specificity of 85{\%} (82-88).Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.",
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N2 - Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme.Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed.Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52-88) and a specificity of 90% (87-93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82-98) and a specificity of 87% (84-90), and for colour slides, a sensitivity of 96% (87-100) and a specificity of 89% (86-91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77-89) and a specificity of 71% (66-75) and diabetic macular oedema with a sensitivity of 76% (53-92) and a specificity of 85% (82-88).Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.

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