Diabetic Eye Screening: Evaluation and Comparison of the Grading Results Between Community and Hospital Eye Services.

IF 2.4 Q3 OPHTHALMOLOGY

Clinical Optometry Pub Date : 2025-12-15 eCollection Date: 2025-01-01 DOI:10.2147/OPTO.S533954

Christopher Stewart, Mokhalad Al-Duhaimi, Jaskaran Singh Bhangu, Rebecca John, Gwyn Samuel Williams, Mahmoud Husseiny Awad

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Abstract

Background: Diabetes is a significant global health crisis, affecting approximately 828 million individuals worldwide, including 5.6 million in the UK and an estimated 212,000 in Wales. Diabetic Retinopathy (DR) is a leading cause of blindness in the UK and severely impacts the working-age population. Effective screening programs are vital for early detection and intervention, as prolonged diabetes increases the risk of developing DR. Since 2003, Diabetic Eye Screening Wales (DESW) has coordinated DR screening in Wales, but no studies have assessed grading agreement across the screening pathway.

Methods: This retrospective study analysed data from January 2021 to December 2023, involving 762 eyes from 486 patients referred across different grading levels. The RxMx system was used to classify retinopathy and maculopathy. The agreement between primary graders (DESW) and secondary graders (community optometrists) was compared, along with that between secondary and tertiary graders (hospital eye services). Percentage agreement and weighted Cohen's Kappa were calculated to assess interobserver reliability.

Results: The percentage agreement was 60.4% (weighted Cohen's Kappa of 0.423, indicating moderate agreement) between primary and secondary graders for retinopathy. For maculopathy, the agreement was 69.6% (weighted Cohen's Kappa of 0.42). Between secondary and tertiary graders, the percentage agreement for retinopathy was 61.5% (Kappa of 0.634, indicating substantial agreement), while for maculopathy, it was 75.0% (Kappa of 0.618).

Conclusion: The findings show fair agreement between primary and secondary graders and a substantial agreement between secondary and tertiary graders. These results highlight concerns regarding the reliability of current screening practices and suggest incorporating optical coherence tomography (OCT) to enhance grading accuracy. Additionally, implementation of personalised risk-based screening may help reduce the burden of DR on healthcare services, although consideration is necessary to prevent exacerbating existing health inequalities. An electronic system for shared imaging data could further improve screening reliability and grader competency assessment.

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糖尿病眼筛查：社区与医院眼科服务分级结果的评价与比较。

背景：糖尿病是一个重大的全球健康危机，影响着全球约8.28亿人，其中包括英国的560万人和威尔士的约212,000人。糖尿病视网膜病变（DR）是英国失明的主要原因，严重影响了工作年龄人口。有效的筛查方案对于早期发现和干预至关重要，因为长期糖尿病会增加发生DR的风险。自2003年以来，威尔士糖尿病眼科筛查（DESW）在威尔士协调了DR筛查，但没有研究评估了筛查途径的分级一致性。方法：本回顾性研究分析了2021年1月至2023年12月的数据，涉及不同分级的486例患者的762只眼睛。RxMx系统用于视网膜病变和黄斑病变的分类。比较了小学年级学生（DESW）和中学年级学生（社区验光师）以及中学和大学年级学生（医院眼科服务）之间的一致性。计算一致性百分比和加权Cohen’s Kappa来评估观察者间的信度。结果：小学和初中学生视网膜病变的一致性百分比为60.4%（加权Cohen’s Kappa为0.423，表明中度一致性）。对于黄斑病变，一致性为69.6%（加权科恩Kappa为0.42）。在二年级和三年级之间，视网膜病变的一致性百分比为61.5% （Kappa为0.634，表明基本一致），而黄斑病变的一致性百分比为75.0% （Kappa为0.618）。结论：调查结果显示，小学和初中学生之间的一致性比较好，初中和大学学生之间的一致性比较好。这些结果突出了对当前筛查实践可靠性的关注，并建议采用光学相干断层扫描（OCT）来提高分级准确性。此外，实施个性化的基于风险的筛查可能有助于减轻DR对保健服务的负担，尽管有必要考虑防止加剧现有的保健不平等。共享成像数据的电子系统可以进一步提高筛查的可靠性和评分员的能力评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Optometry OPHTHALMOLOGY-

CiteScore

3.00

自引率

5.90%

发文量

审稿时长

16 weeks

期刊介绍： Clinical Optometry is an international, peer-reviewed, open access journal focusing on clinical optometry. All aspects of patient care are addressed within the journal as well as the practice of optometry including economic and business analyses. Basic and clinical research papers are published that cover all aspects of optics, refraction and its application to the theory and practice of optometry. Specific topics covered in the journal include: Theoretical and applied optics, Delivery of patient care in optometry practice, Refraction and correction of errors, Screening and preventative aspects of eye disease, Extended clinical roles for optometrists including shared care and provision of medications, Teaching and training optometrists, International aspects of optometry, Business practice, Patient adherence, quality of life, satisfaction, Health economic evaluations.