Addressing Technical Failures in a Diabetic Retinopathy Screening Program

Abstract

Purpose Diabetic retinopathy (DR) is a preventable cause of blindness detectable through screening using retinal digital photography. The Irish National Diabetic Retina Screening (DRS) programme, Diabetic RetinaScreen, provides free screening services to patients with diabetes from aged 12 years and older. A technical failure (TF) occurs when digital retinal imaging is ungradable, resulting in delays in the diagnosis and treatment of sight-threatening disease. Despite their impact, the causes of TFs, and indeed the utility of interventions to prevent them, have not been extensively examined. Aim Primary analysis aimed to identify factors associated with TF. Secondary analysis examined a subset of cases, assessing patient data from five time points between 2019 and 2021 to identify photographer/patient factors associated with TF. Methods Patient data from the DRS database for one provider were extracted for analysis between 2018 and 2022. Information on patient demographics, screening results, and other factors previously associated with TF were analyzed. Primary analysis involved using mixed-effects logistic regression models with nested patient-eye random effects. Secondary analysis reviewed a subset of cases in detail, checking for causes of TF. Results The primary analysis included a total of 366,528 appointments from 104,407 patients over 5 years. Most patients had Type 2 diabetes (89.2%), and the overall TF rate was 4.9%. Diabetes type and duration, dilate pupil status, and the presence of lens artefacts on the camera were significantly associated with TF. The Secondary analysis identified the primary cause of TF was found to be optically dense cataracts, accounting for over half of the TFs. Conclusion This study provides insight into the causes of TF within the Irish DRS program, highlighting cataracts as the primary contributing factor. The identification of patient-level factors associated with TF facilitates appropriate interventions that can be put in place to improve patient outcomes and minimize delays in treatment and diagnosis.

Addressing Technical Failures in a Diabetic Retinopathy Screening Program [Letter]

“…In this research, Ian Gerard Brennan et al found that the type and duration of diabetes, dilated pupil status, and the presence of a lens on the device used for screening were significantly related to technical failure (TF). 1 Therefore we recommend that try Multimodal Imaging Techniques and Potential Future Directions which uses several imaging methods to check the quantity of retinal thickness and precise mapping of retinal topography. This is useful in assessing retinal thickness in non-clinically significant macular edema and clinically significant macular edema.…”

“…In conclusion we agree that it is important to carry out comprehensive interventions aimed at reducing TF rates and increasing the effectiveness of Diabetic Retina Screening programs to determine the significant impact of patient factors, especially cataracts, on TF rates. 1 As additional information, it is important to know that retinal imaging is a key component in the diagnosis and management of DR patients and a multimodal imaging approach is key, as multiple imaging modalities including dye-based fluorescein and optical coherence tomography angiography can provide clinically important complementary information. 3 …”

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We have read the paper written by Ian Gerard Brennan et al on Addressing Technical Failures in a Diabetic Retinopathy Screening Program. 1 We congratulate all authors who have provided important information regarding Diabetic Retinopathy (DR), which is a cause of blindness, through screening using digital retinal photography. DR is the most common cause of vision loss caused by damage to the small blood vessels in the retina.

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“…3 The study conducted by Ian Gerard Brennan et al used a screening protocol and DR assessment from patient data (patient demographics, screening results, and other factors) in the National Diabetic Retina Screening database for 2018 and 2022 for analysis. 1 The method used was appropriate with the objectives to be achieved, however, to carry out screening on DR patients, the following must be taken into account: (1) The examination method must be appropriate to the screening area, and the DR assessment system must be applied systematically and uniformly; (2) performed in an ophthalmology clinic; (3) staff conducting screening must be accredited; (4) screening programs must comply with relevant national quality assurance standards; (5) use uniform standards to determine optimal risk-based inspection intervals; (6) technological infrastructure must be in place to ensure that high-quality images can be stored securely to protect patient information. 4 In this research, Ian Gerard Brennan et al found that the type and duration of diabetes, dilated pupil status, and the presence of a lens on the device used for screening were significantly related to technical failure (TF).…”