The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya
BackgroundDiabetes is rapidly becoming a major cause of blindness among Kenyans, with the prevalence of any form of diabetes retinopathy (DR) ranging from 36% to 41%. Globally DR leads as a cause of vision loss in working age adults. In Kenya, specialized examinations are only available at national...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Ophthalmology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fopht.2023.1082205/full |
| _version_ | 1797847240620900352 |
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| author | Jane Rahedi Ong’ang’o Olga Mashedi Micheal Gichangi Richard Kiplimo Joseph Nyamori Kennedy Alwenya |
| author_facet | Jane Rahedi Ong’ang’o Olga Mashedi Micheal Gichangi Richard Kiplimo Joseph Nyamori Kennedy Alwenya |
| author_sort | Jane Rahedi Ong’ang’o |
| collection | DOAJ |
| description | BackgroundDiabetes is rapidly becoming a major cause of blindness among Kenyans, with the prevalence of any form of diabetes retinopathy (DR) ranging from 36% to 41%. Globally DR leads as a cause of vision loss in working age adults. In Kenya, specialized examinations are only available at national and some county referral hospitals through retina specialists, ophthalmologists or trained technicians. Thus, low coverage of retinal assessment and inadequate access to this service. An innovative DR fundus camera screening service run by ophthalmic nurses (ONs), ophthalmic clinical officers (OCOs) and county ophthalmologists was established since 2018.ObjectivesThe purpose of this study was to investigate the diagnostic accuracy of DR digital retinal camera screening by ONs, OCOs and county ophthalmologist against that of a retina specialist measured by sensitivity and specificity as the primary outcomes.MethodsCross sectional study conducted at 2 referral hospitals in Kenya. Using a Canon CR-2AF digital retinal camera patients with diabetes had a standard single shot of 45 degree view of the retina captured as image in each eye. This was graded for DR using the International Clinical Diabetic Retinopathy (ICDR) severity scale. All photos taken by the first graders (ON/OCO) were later assessed by the county hospital ophthalmologist who was blinded to their readings. The third grader (retina specialist) similarly was blinded to the readings of the first and second graders and assessed all the images from the 2 hospitals also using ICDR.ResultsA total of 308 patients with diabetes (median age 58 IQR 56-60, 53% female) were enrolled in the study. Sensitivity to identify any DR was (81.3%, 80.6%, and 81.54% for the OCO, ON and county ophthalmologist respectively). The corresponding specificities were 92.7%, 92.8% and 92.59%. Analysis of diagnostic accuracy of non-sight threatening DR against sight threatening DR revealed lower sensitivity for the three cadre groups although specificity remained high.ConclusionsIn this study, ON and OCO with basic training in DR screening and photo grading performed screening of DR with high specificity. However, the sensitivity to detect sight threatening DR was generally low by all the cadres which may leave severe forms of DR undetected. |
| first_indexed | 2024-04-09T18:09:13Z |
| format | Article |
| id | doaj.art-a4579beb3ddd415099735146837af96e |
| institution | Directory Open Access Journal |
| issn | 2674-0826 |
| language | English |
| last_indexed | 2024-04-09T18:09:13Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Ophthalmology |
| spelling | doaj.art-a4579beb3ddd415099735146837af96e2023-04-14T04:37:46ZengFrontiers Media S.A.Frontiers in Ophthalmology2674-08262023-04-01310.3389/fopht.2023.10822051082205The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, KenyaJane Rahedi Ong’ang’o0Olga Mashedi1Micheal Gichangi2Richard Kiplimo3Joseph Nyamori4Kennedy Alwenya5Centre for Respiratory Diseases, Kenya Medical Research Institute, Nairobi, KenyaCentre for Respiratory Diseases, Kenya Medical Research Institute, Nairobi, KenyaOphthalmic Services Unit, Ministry of Health, Nairobi, KenyaCentre for Respiratory Diseases, Kenya Medical Research Institute, Nairobi, KenyaDepartment of Ophthalmology, University of Nairobi, Nairobi, KenyaMonitoring and Evaluation Unit, Fred Hollows Foundation Kenya, Nairobi, KenyaBackgroundDiabetes is rapidly becoming a major cause of blindness among Kenyans, with the prevalence of any form of diabetes retinopathy (DR) ranging from 36% to 41%. Globally DR leads as a cause of vision loss in working age adults. In Kenya, specialized examinations are only available at national and some county referral hospitals through retina specialists, ophthalmologists or trained technicians. Thus, low coverage of retinal assessment and inadequate access to this service. An innovative DR fundus camera screening service run by ophthalmic nurses (ONs), ophthalmic clinical officers (OCOs) and county ophthalmologists was established since 2018.ObjectivesThe purpose of this study was to investigate the diagnostic accuracy of DR digital retinal camera screening by ONs, OCOs and county ophthalmologist against that of a retina specialist measured by sensitivity and specificity as the primary outcomes.MethodsCross sectional study conducted at 2 referral hospitals in Kenya. Using a Canon CR-2AF digital retinal camera patients with diabetes had a standard single shot of 45 degree view of the retina captured as image in each eye. This was graded for DR using the International Clinical Diabetic Retinopathy (ICDR) severity scale. All photos taken by the first graders (ON/OCO) were later assessed by the county hospital ophthalmologist who was blinded to their readings. The third grader (retina specialist) similarly was blinded to the readings of the first and second graders and assessed all the images from the 2 hospitals also using ICDR.ResultsA total of 308 patients with diabetes (median age 58 IQR 56-60, 53% female) were enrolled in the study. Sensitivity to identify any DR was (81.3%, 80.6%, and 81.54% for the OCO, ON and county ophthalmologist respectively). The corresponding specificities were 92.7%, 92.8% and 92.59%. Analysis of diagnostic accuracy of non-sight threatening DR against sight threatening DR revealed lower sensitivity for the three cadre groups although specificity remained high.ConclusionsIn this study, ON and OCO with basic training in DR screening and photo grading performed screening of DR with high specificity. However, the sensitivity to detect sight threatening DR was generally low by all the cadres which may leave severe forms of DR undetected.https://www.frontiersin.org/articles/10.3389/fopht.2023.1082205/fulldiabetes retinopathysensitivityspecificityophthalmic nurseophthalmic clinical officercounty ophthalmologist |
| spellingShingle | Jane Rahedi Ong’ang’o Olga Mashedi Micheal Gichangi Richard Kiplimo Joseph Nyamori Kennedy Alwenya The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya Frontiers in Ophthalmology diabetes retinopathy sensitivity specificity ophthalmic nurse ophthalmic clinical officer county ophthalmologist |
| title | The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya |
| title_full | The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya |
| title_fullStr | The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya |
| title_full_unstemmed | The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya |
| title_short | The diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers, ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals, Kenya |
| title_sort | diagnostic accuracy of diabetes retinopathy screening by ophthalmic clinical officers ophthalmic nurses and county ophthalmologists against a retina specialist in 2 selected county referral hospitals kenya |
| topic | diabetes retinopathy sensitivity specificity ophthalmic nurse ophthalmic clinical officer county ophthalmologist |
| url | https://www.frontiersin.org/articles/10.3389/fopht.2023.1082205/full |
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