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To validate the fundus image grading results by a trained grader (Non-ophthalmologist) and an ophthalmologist grader for detecting diabetic retinopathy (DR) and diabetic macular oedema (DMO) against fundus examination by a retina specialist (gold standard).
A prospective diagnostic accuracy study was conducted using 2002 non-mydriatic colour fundus images from 1001 patients aged ≥40 years. Using the Aravind Diabetic Retinopathy Evaluation Software (ADRES) images were graded by both a trained non-ophthalmologist grader (grader-1) and an ophthalmologist (grader-2). Sensitivity, specificity, positive predictive value and negative predictive value were calculated for grader-1 and grader-2 against the grading results by an independent retina specialist who performed dilated fundus examination for every study participant.
Out of 1001 patients included, 42% were women and the mean ± (SD) age was 55.8 (8.39) years. For moderate or worse DR, the sensitivity and specificity for grading by grader-1 with respect to the gold standard was 66.9% and 91.0% respectively and the same for the ophthalmologist was 83.6% and 80.3% respectively. For referable DMO, grader-1 and grader-2 had a sensitivity of 74.6% and 85.6% respectively and a specificity of 83.7% and 79.8% respectively.
Our results demonstrate good level of accuracy for the fundus image grading performed by a trained non-ophthalmologist which was comparable with the grading by an ophthalmologist. Engaging trained non-ophthalmologists potentially can enhance the efficiency of DR diagnosis using fundus images. Further study with multiple non-ophthalmologist graders is needed to verify the results and strategies to improve agreement for DMO diagnosis are needed.
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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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The authors acknowledge the cooperation and support from the staff and management of Aravind Eye Hospital, Madurai, India during the study.
This study was internally funded by the Aravind Eye Care System and the personnel dealing with funds allocation did not have any influence on the study procedures or interpretation of the results.
Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
Sanil Joseph & Soundarya Venkatachalam
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Vic, Australia
Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Vic, Australia
Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
Renu P. Rajan, Balagiri Sundar & Ramasamy Kim
Department of Ophthalmology, , Massachusetts Eye and Ear and Harvard Medical School; Schepens Eye Research Institute, Boston, MA, USA
MCM Eye Unit, MyungSung Christian Medical Center (MCM) Multispecialty Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
Department of Ophthalmology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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SJ, RK and RPR were responsible for conception, design and implementation of the study. SV contributed to data management and manuscript preparation. SJ and BS were responsible for data analysis and interpretation of the results. SJ led preparation of the manuscript with contribution from all co-authors. JHK did a thorough review of the final draft of the manuscript and contributed substantially in finalizing it.
The authors declare no competing interests.
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Joseph, S., Rajan, R.P., Sundar, B. et al. Validation of diagnostic accuracy of retinal image grading by trained non-ophthalmologist grader for detecting diabetic retinopathy and diabetic macular edema. Eye (2022). https://doi.org/10.1038/s41433-022-02190-4
DOI: https://doi.org/10.1038/s41433-022-02190-4
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