0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Evaluation of Automated Teleretinal Screening Program for Diabetic Retinopathy

O. Bennett Walton IV, MD, MBA1,2; Robert B. Garoon, MD1,2; Christina Y. Weng, MD, MBA1,2; Jacob Gross, MD3; Alex K. Young, MD4; Kathryn A. Camero, MD4; Haoxing Jin, BS4; Petros E. Carvounis, MD, FRCSC1,2; Robert E. Coffee, MD, MPH1,2; Yvonne I. Chu, MD1,2
[+] Author Affiliations
1Harris Health System, Houston, Texas
2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
3The University of Texas Medical School at Houston
4School of Medicine, Baylor College of Medicine, Houston, Texas
JAMA Ophthalmol. 2016;134(2):204-209. doi:10.1001/jamaophthalmol.2015.5083.
Text Size: A A A
Published online

Importance  Diabetic retinopathy is a leading cause of blindness, but its detrimental effects are preventable with early detection and treatment. Screening for diabetic retinopathy has the potential to increase the number of cases treated early, especially in populations with limited access to care.

Objective  To determine the efficacy of an automated algorithm in interpreting screening ophthalmoscopic photographs from patients with diabetes compared with a reading center interpretation.

Design, Setting, and Participants  Retrospective cohort analysis of 15 015 patients with type 1 or 2 diabetes in the Harris Health System in Harris County, Texas, who had undergone a retinal screening examination and nonmydriatic fundus photography via the Intelligent Retinal Imaging System (IRIS) from June 2013 to April 2014 were included. The IRIS-based interpretations were compared with manual interpretation. The IRIS algorithm population statistics were calculated.

Main Outcomes and Measures  Sensitivity and false-negative rate of the IRIS computer-based algorithm compared with reading center interpretation of the same images.

Results  A total of 15 015 consecutive patients (aged 18-98 years); mean 54.3 years with known type 1 or 2 diabetes underwent nonmydriatic fundus photography for a diabetic retinopathy screening examination. The sensitivity of the IRIS algorithm in detecting sight-threatening diabetic eye disease compared with the reading center interpretation was 66.4% (95% CI, 62.8%-69.9%) with a false-negative rate of 2%. The specificity was 72.8% (95% CI, 72.0%-73.5%). In a population where 15.8% of people with diabetes have sight-threatening diabetic eye disease, the IRIS algorithm positive predictive value was 10.8% (95% CI, 9.6%-11.9%) and the negative predictive value was 97.8% (95% CI, 96.8%-98.6%).

Conclusions and Relevance  In this large urban setting, the IRIS computer algorithm-based screening program had a high sensitivity and a low false–negative rate, suggesting that it may be an effective alternative to conventional reading center image interpretation. The IRIS algorithm shows promise as a screening program, but algorithm refinement is needed to achieve better performance. Further studies of patient safety, cost-effectiveness, and widespread applications of this type of algorithm should be pursued to better understand the role of teleretinal imaging and automated analysis in the global health care system.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure.
Examples of Intelligent Retinal Imaging System–Captured Ophthalmoscopic Photographs

A, Photograph of left fundus shows preretinal hemorrhage and extensive neovascularization consistent with proliferative diabetic retinopathy. B, Intelligent Retinal Imaging System–enhanced photograph of right fundus demonstrates intraretinal hemorrhage and circinate ring of exudates consistent with severe nonproliferative diabetic retinopathy.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

937 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();