Utility of 1% Tropicamide in Improving the Quality of Images for Tele-Screening of Diabetic Retinopathy in Patients with Dark Irides

Banaee, Touka; Ansari-Astaneh, Mohammad-Reza; Pourreza, Hamid Reza; Hosseini, Fatemeh Faal; Vatanparast, Maryam; Shoeibi, Nasser; Jami, Vajihe

doi:10.1080/09286586.2016.1274039

Cited by 14 publications

(18 citation statements)

References 12 publications

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“…Non-mydriatic imaging can be used in settings where there are fewer ophthalmic personnel and avoiding pupil dilatation reduces screening time and causes less perceived inconvenience to PwDM. A concern, however, is variability in image quality, particularly in populations with a high prevalence of cataract and corneal opacities [ 14 , 52 ]. The Scottish National Health Services DRSP now uses non-mydriatic imaging systems, with minimal need for pupil dilatation in screened patients [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

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Systematic review and meta-analysis of diagnostic accuracy of detection of any level of diabetic retinopathy using digital retinal imaging

et al. 2018

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BackgroundVisual impairment from diabetic retinopathy (DR) is an increasing global public health concern, which is preventable with screening and early treatment. Digital retinal imaging has become a preferred choice as it enables higher coverage of screening. The aim of this review is to evaluate how different characteristics of the DR screening (DRS) test impact on diagnostic test accuracy (DTA) and its relevance to a low-income setting.MethodsWe conducted a systematic literature search to identify clinic-based studies on DRS using digital retinal imaging of people with DM (PwDM). Summary estimates of different sub-groups were calculated using DTA values weighted according to the sample size. The DTA of each screening method was derived after exclusion of ungradable images and considering the eye as the unit of analysis. The meta-analysis included studies which measured DTA of detecting any level of DR. We also examined the effect on detection from using different combinations of retinal fields, pupil status, index test graders and setting.ResultsSix thousand six hundred forty-six titles and abstracts were retrieved, and data were extracted from 122 potentially eligible full reports. Twenty-six studies were included in the review, and 21 studies, mostly from high-income settings (18/21, 85.7%), were included in the meta-analysis. The highest sensitivity was observed in the mydriatic greater than two field strategy (92%, 95% CI 90–94%). The highest specificity was observed in greater than two field methods (94%, 95% CI 93–96%) where mydriasis did not affect specificity. Overall, there was no difference in sensitivity between non-mydriatic and mydriatic methods (86%, 95% CI 85–87) after exclusion of ungradable images. The highest DTA (sensitivity 90%, 95% CI 88–91%; specificity 95%, 95% CI 94–96%) was observed when screening was delivered at secondary/tertiary level clinics.ConclusionsNon-mydriatic two-field strategy could be a more pragmatic approach in starting DRS programmes for facility-based PwDM in low-income settings, with dilatation of the pupils of those who have ungradable images. There was insufficient evidence in primary studies to draw firm conclusions on how graders’ background influences DTA. Conducting more context-specific DRS validation studies in low-income and non-ophthalmic settings can be recommended.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0846-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Non-mydriatic digital imaging methods cause less discomfort and are more convenient for service providers. However, poor image quality is an important limitation of digital retinal imaging, particularly if non-mydriatic systems are being used, in countries where cataract is common [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of diagnostic accuracy of detection of any level of diabetic retinopathy using digital retinal imaging

et al. 2018

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“…We could not achieve a higher level of sensitivity comparable with the studies done in HICs, due to poor image quality. The main causes of poor image quality are dark iris colour, poor pupil dilation status and lens opacity [13,29]. In HICs prevalence of cataract is less compared to LMICs like Sri Lanka [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

“…Nonmydriatic imaging has lower resolution and lower image quality leading to poorer detection of DR [13,40]. However, digital imaging has lower technical failure rates than imaging using colour slides [41].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Test Accuracy of Diabetic Retinopathy Screening by Physician Graders Using a Hand Held Non-Mydriatic Retinal Camera at a Tertiary Level Medical Clinic in a Lower-Middle Income Country Setting

Piyasena

Yip

Macleod

et al. 2018

Preprint

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Background We identified that there was less evidence on diagnostic test accuracy (DTA) of diabetic retinopathy (DR) screening photographic studies that have used non-ophthalmologist human resources in low and middle-income country (LMIC) settings. This study is the first to assess the DTA of physician graders using hand held digital imaging in Sri Lanka. We aimed to assess DTA of DR screening using a nonmydriatic hand-held digital camera by trained general physicians in a non-ophthalmic setting. This modality will be useful for adaptation in similar settings. Methods This study is a validation of a screening intervention. We selected people with diabetes (PwDM) not previously screened or treated for DR, presenting at a tertiary medical clinic in Sri Lanka. Two-field retinal imaging was used to capture fundus images before and after pupil dilatation. The images were captured and graded by two trained, masked independent physician graders. The DTA of different levels of DR was assessed comparing physician’s grading with a retinologist’s clinical examination according to a locally adopted guideline. Results Seven hundred eligible PwDM were screened by physician graders. Their mean age was 60.8 years (SD ±10.08) and mean duration of DM was 9.9 years (SD ±8.09). Ungradable image proportion in non-mydriatic imaging was 43.4% (either eye-31.3%, both eyes 12.1%). This decreased to 12.8% (either eye-11.6%, both eyes-1.2%) following pupil dilatation. In comparison to detection of any level of DR, a referable level DR (moderate non-proliferative DR and levels above) showed a higher level of DTA. The sensitivity of the defined referable DR was 88.7% (95% CI 81.7-93.8%) for grader 1 (positive predictive value [PPV] 59.1%) and 92.5% (95% CI 86.4-96.5%) for grader 2 (PPV 68%), using mydriatic imaging, after including ungradable images as screen positives. The specificity was 94.9% (95% CI 93.6-96.0%) for grader 1 (negative predictive value [NPV] 99%) and 96.4% (95% CI 95.3-97.3%) for grader 2 (NPV 99.4%). Conclusions The Physicians grading of images from a digital hand-held nonmydriatic camera was effective in identifying referable DR, following pupil dilatation. This could be a feasible alternative modality to the existing opportunistic screening to improve the access and coverage.

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The effect of topical tropicamide and phenylephrine on macular and peripapillary microvasculature: an optical coherence tomography angiography study

Özdemir

Şekeroğlu

2020

Int Ophthalmol

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Utility of 1% Tropicamide in Improving the Quality of Images for Tele-Screening of Diabetic Retinopathy in Patients with Dark Irides

Cited by 14 publications

References 12 publications

Systematic review and meta-analysis of diagnostic accuracy of detection of any level of diabetic retinopathy using digital retinal imaging

Systematic review and meta-analysis of diagnostic accuracy of detection of any level of diabetic retinopathy using digital retinal imaging

Diagnostic Test Accuracy of Diabetic Retinopathy Screening by Physician Graders Using a Hand Held Non-Mydriatic Retinal Camera at a Tertiary Level Medical Clinic in a Lower-Middle Income Country Setting

The effect of topical tropicamide and phenylephrine on macular and peripapillary microvasculature: an optical coherence tomography angiography study

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