Diabetic Retinopathy Screening at the Point of Care (DR SPOC) : detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
INTRODUCTION: The aim of this study was to determine the prevalence of diabetic retinopathy (DR) in a low socioeconomic region of a high-income country, as well as determine the diagnostic utility of point-of-care screening for high-risk populations in tertiary care settings.
RESEARCH DESIGN AND METHODS: This was a cross-sectional study of patients with diabetes attending foot ulcer or integrated care diabetes clinics at two Western Sydney hospitals (n=273). DR was assessed using portable, two-field, non-mydriatic fundus photography and combined electroretinogram/ pupillometry (ERG). With mydriatic photographs used as the reference standard, sensitivity and specificity of the devices were determined. Prevalence of DR and vision-threatening diabetic retinopathy (VTDR) were reported, with multivariate logistic regression used to identify predictors of DR.
RESULTS: Among 273 patients, 39.6% had any DR, while 15.8% had VTDR, of whom 59.3% and 62.8% were previously undiagnosed, respectively. Non-mydriatic photography demonstrated 20.2% sensitivity and 99.5% specificity for any DR, with a 56.7% screening failure rate. Meanwhile, mydriatic photography produced high-quality images with a 7.6% failure rate. ERG demonstrated 72.5% sensitivity and 70.1% specificity, with a 15.0% failure rate. The RETeval ERG was noted to have an optimal DR cut-off score at 22. Multivariate logistic regression identified an eGFR of ≤29 mL/min/1.73 m2, HbA1c of ≥7.0%, pupil size of <4 mm diameter, diabetes duration of 5-24 years and RETeval score of ≥22 as strong predictors of DR.
CONCLUSION: There is a high prevalence of vision-threatening and undiagnosed DR among patients attending high-risk tertiary clinics in Western Sydney. Point-of-care DR screening using portable, mydriatic photography demonstrates potential as a model of care which is easily accessible, targeted for high-risk populations and substantially enhances DR detection.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
BMJ open diabetes research & care - 11(2023), 4 vom: 02. Aug. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Weerasinghe, Lakni Shahanika [VerfasserIn] |
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| Links: |
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| Themen: |
Diabetic Retinopathy |
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| Anmerkungen: |
Date Completed 04.08.2023 Date Revised 07.08.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1136/bmjdrc-2023-003376 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Weerasinghe, Lakni Shahanika |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Diabetic Retinopathy Screening at the Point of Care (DR SPOC) |b detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services |
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| 520 | |a © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a INTRODUCTION: The aim of this study was to determine the prevalence of diabetic retinopathy (DR) in a low socioeconomic region of a high-income country, as well as determine the diagnostic utility of point-of-care screening for high-risk populations in tertiary care settings | ||
| 520 | |a RESEARCH DESIGN AND METHODS: This was a cross-sectional study of patients with diabetes attending foot ulcer or integrated care diabetes clinics at two Western Sydney hospitals (n=273). DR was assessed using portable, two-field, non-mydriatic fundus photography and combined electroretinogram/ pupillometry (ERG). With mydriatic photographs used as the reference standard, sensitivity and specificity of the devices were determined. Prevalence of DR and vision-threatening diabetic retinopathy (VTDR) were reported, with multivariate logistic regression used to identify predictors of DR | ||
| 520 | |a RESULTS: Among 273 patients, 39.6% had any DR, while 15.8% had VTDR, of whom 59.3% and 62.8% were previously undiagnosed, respectively. Non-mydriatic photography demonstrated 20.2% sensitivity and 99.5% specificity for any DR, with a 56.7% screening failure rate. Meanwhile, mydriatic photography produced high-quality images with a 7.6% failure rate. ERG demonstrated 72.5% sensitivity and 70.1% specificity, with a 15.0% failure rate. The RETeval ERG was noted to have an optimal DR cut-off score at 22. Multivariate logistic regression identified an eGFR of ≤29 mL/min/1.73 m2, HbA1c of ≥7.0%, pupil size of <4 mm diameter, diabetes duration of 5-24 years and RETeval score of ≥22 as strong predictors of DR | ||
| 520 | |a CONCLUSION: There is a high prevalence of vision-threatening and undiagnosed DR among patients attending high-risk tertiary clinics in Western Sydney. Point-of-care DR screening using portable, mydriatic photography demonstrates potential as a model of care which is easily accessible, targeted for high-risk populations and substantially enhances DR detection | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Diabetic Retinopathy | |
| 650 | 4 | |a Early Diagnosis | |
| 650 | 4 | |a Eye | |
| 650 | 4 | |a Point-of-Care Systems | |
| 650 | 7 | |a Mydriatics |2 NLM | |
| 700 | 1 | |a Dunn, Hamish Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Fung, Adrian T |e verfasserin |4 aut | |
| 700 | 1 | |a Maberly, Glen |e verfasserin |4 aut | |
| 700 | 1 | |a Cheung, Ngai Wah |e verfasserin |4 aut | |
| 700 | 1 | |a Weerasinghe, Daminda P |e verfasserin |4 aut | |
| 700 | 1 | |a Liew, Gerald |e verfasserin |4 aut | |
| 700 | 1 | |a Do, Helen |e verfasserin |4 aut | |
| 700 | 1 | |a Hng, Tien-Ming |e verfasserin |4 aut | |
| 700 | 1 | |a Pryke, Alison |e verfasserin |4 aut | |
| 700 | 1 | |a Marks, Samuel I |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyen, Helen |e verfasserin |4 aut | |
| 700 | 1 | |a Jayaballa, Rajini |e verfasserin |4 aut | |
| 700 | 1 | |a Gurung, Seema |e verfasserin |4 aut | |
| 700 | 1 | |a Ford, Belinda |e verfasserin |4 aut | |
| 700 | 1 | |a Bishay, Ramy H |e verfasserin |4 aut | |
| 700 | 1 | |a Girgis, Christian M |e verfasserin |4 aut | |
| 700 | 1 | |a Meyerowitz-Katz, Gideon |e verfasserin |4 aut | |
| 700 | 1 | |a Keay, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a White, Andrew J |e verfasserin |4 aut | |
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