Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services
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 metho...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-07-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/11/4/e003376.full |
| _version_ | 1797729990418104320 |
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| author | Lisa Keay Gerald Liew Adrian T Fung Ngai Wah Cheung Tien-Ming Hng Christian M Girgis Glen Maberly Helen Nguyen Andrew J White Gideon Meyerowitz-Katz Lakni Shahanika Weerasinghe Hamish Paul Dunn Daminda P Weerasinghe Helen Do Alison Pryke Samuel I Marks Rajini Jayaballa Seema Gurung Belinda Ford Ramy H Bishay |
| author_facet | Lisa Keay Gerald Liew Adrian T Fung Ngai Wah Cheung Tien-Ming Hng Christian M Girgis Glen Maberly Helen Nguyen Andrew J White Gideon Meyerowitz-Katz Lakni Shahanika Weerasinghe Hamish Paul Dunn Daminda P Weerasinghe Helen Do Alison Pryke Samuel I Marks Rajini Jayaballa Seema Gurung Belinda Ford Ramy H Bishay |
| author_sort | Lisa Keay |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T11:38:42Z |
| format | Article |
| id | doaj.art-9d7683a96cff45cabb020c987f416f70 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-03-12T11:38:42Z |
| publishDate | 2023-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-9d7683a96cff45cabb020c987f416f702023-09-01T03:00:07ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972023-07-0111410.1136/bmjdrc-2023-003376Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing servicesLisa Keay0Gerald Liew1Adrian T Fung2Ngai Wah Cheung3Tien-Ming Hng4Christian M Girgis5Glen Maberly6Helen Nguyen7Andrew J White8Gideon Meyerowitz-Katz9Lakni Shahanika Weerasinghe10Hamish Paul Dunn11Daminda P Weerasinghe12Helen Do13Alison Pryke14Samuel I Marks15Rajini Jayaballa16Seema Gurung17Belinda Ford18Ramy H Bishay19School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, AustraliaDepartment of Ophthalmology, Westmead Hospital, Westmead, New South Wales, AustraliaDepartment of Ophthalmology, Westmead Hospital, Westmead, New South Wales, AustraliaDepartment of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, AustraliaDepartment of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, AustraliaFaculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, AustraliaFaculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, AustraliaSchool of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, AustraliaFaculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, AustraliaDepartment of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, AustraliaFaculty of Medicine, University of New South Wales, Kensington, New South Wales, AustraliaDepartment of Ophthalmology, Westmead Hospital, Westmead, New South Wales, AustraliaDepartment of Mathematics and Statistics, Macquarie University, Sydney, New South Wales, AustraliaDepartment of Ophthalmology, Westmead Hospital, Westmead, New South Wales, AustraliaDepartment of Ophthalmology, Westmead Hospital, Westmead, New South Wales, AustraliaFaculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, AustraliaDepartment of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, AustraliaDepartment of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, AustraliaFaculty of Medicine, University of New South Wales, Kensington, New South Wales, AustraliaDepartment of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, AustraliaIntroduction 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.https://drc.bmj.com/content/11/4/e003376.full |
| spellingShingle | Lisa Keay Gerald Liew Adrian T Fung Ngai Wah Cheung Tien-Ming Hng Christian M Girgis Glen Maberly Helen Nguyen Andrew J White Gideon Meyerowitz-Katz Lakni Shahanika Weerasinghe Hamish Paul Dunn Daminda P Weerasinghe Helen Do Alison Pryke Samuel I Marks Rajini Jayaballa Seema Gurung Belinda Ford Ramy H Bishay Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services BMJ Open Diabetes Research & Care |
| title | Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services |
| title_full | Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services |
| title_fullStr | Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services |
| title_full_unstemmed | Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services |
| title_short | Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services |
| title_sort | diabetic retinopathy screening at the point of care dr spoc detecting undiagnosed and vision threatening retinopathy by integrating portable technologies within existing services |
| url | https://drc.bmj.com/content/11/4/e003376.full |
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