Two-field non-mydriatic fundus photography for diabetic retinopathy screening: a protocol for a systematic review and meta-analysis

Abstract

IntroductionDiabetic retinopathy (DR) is one of the most prevalent microvascular complications of diabetes mellitus. Guidelines for DR screening in different countries vary greatly, including fundus photography, slit-lamp biomicroscopy, indirect ophthalmoscopy, Optical Coherence Tomography (OCT), OCT-A and Fundus Fluorescein Angiography (FFA). Two-field non-mydriatic fundus photography (NMFP) is an effective screening method due to its low cost and less time-consuming process. However, it is controversial due to the sensitivity and specificity of two-field NMFP. This review intends to evaluate the performance of the two-field NMFP in diagnosing DR and helps clinicians determine the most optimal screening method.Methods and analysisTwo reviewers will independently search on the Medline, Embase, Cochrane databases, ProQuest, Opengrey, Chinese National Knowledge Infrastructure, Wanfang Data, VIP China Science and Technology Journal Database, Chinese BioMedical Literature Database, ISRCTN, ClinicalTrials.gov and the WHO ICTRP to identify relevant studies. There is no restriction posed on the language of the study. Included studies focus on the performance of two-field NMFP in detecting DR in diabetes patients. Analysis and evaluation of the studies will be examined by two reviewers independently using the Quality Assessment for Diagnostic Accuracy Studies-2 tool and later evaluated using the Population, Intervention, Comparison, Outcome, Study design criteria. A random-effect model will calculate the diagnostic indicators, including the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR, area under the curve and 95% CIs. We will also develop a summary receiver operating characteristic curve. We anticipate analysing subgroups according to the factors, which may lead to heterogeneity, including DR levels of patients, the reference standards, camera models, the interpretation criteria. The data will be analysed by STATA software. This study was registered with PROSPERO.Ethics and disseminationThis review will analyse the published data. Patients/the public were not involved in this research. The results of this study will be published in peer-reviewed journals.PROSPERO registration numberCRD42020203608.

Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents

“…Diabetes is a growing, life-debilitating disease that may be considered an epidemic ( Forbes & Cooper, 2013 ; Yu et al, 2021 ). Unrecognized diabetes forms a significant part of the total prevalence and remains a public health challenge ( Centers for Disease Control and Prevention, Data and Statistics, 2022 ).…”

Implementación de cámara no midriática en tamizaje de pacientes diabéticos en una unidad de atención primaria oftalmológica

“…Estas diferencias reportadas en la sensibilidad y especificidad del examen de retinografía puede estar influenciado por la calidad de la imagen de la cámara no midriática y por el número de fotografías y campos evaluados en el examen, ya que los protocolos de evaluación varían entre diferentes países 12 . Es así como podemos encontrar que frecuentemente se pueden utilizar siete, tres, dos y un campo, obteniendo diferentes valores de sensibilidad y especificidad para cada uno de los protocolos, siendo el protocolo de dos campos la estrategia más utilizada para el tamizaje y detección de RD 12 , debido a sus adecuados valores de sensibilidad y especificidad (sobre el 80%) y por la reducción del tiempo de examen. A nivel nacional, con la implementación del programa de teleoftalmología, este protocolo de dos campos es el utilizado en todas las UAPO de Chile.…”

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

“…While mydriatic fundus imaging is generally preferred due to higher quality images, the use of a pupil dilators requires more time, a darkened room, investigator expertise, and is not always feasible or tolerated in certain studies or study populations. However, as noted in two recent reviews, the continued development and advancement non-mydriatic fundus photography systems and techniques are ongoing and, thus, the quality and acceptability of non-mydriatic fundus imaging continues to improve [69, 70].…”