Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services

IntroductionThe 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 method...

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Published in:	BMJ open diabetes research & care Vol. 11; no. 4; p. e003376
Main Authors:	Weerasinghe, Lakni Shahanika, Dunn, Hamish Paul, Fung, Adrian T, Maberly, Glen, Cheung, Ngai Wah, Weerasinghe, Daminda P, Liew, Gerald, Do, Helen, Hng, Tien-Ming, Pryke, Alison, Marks, Samuel I, Nguyen, Helen, Jayaballa, Rajini, Gurung, Seema, Ford, Belinda, Bishay, Ramy H, Girgis, Christian M, Meyerowitz-Katz, Gideon, Keay, Lisa, White, Andrew J
Format:	Journal Article
Language:	English
Published:	England American Diabetes Association 01-08-2023 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Accuracy Cameras Cross-Sectional Studies Diabetes Diabetes Mellitus Diabetic Retinopathy Diabetic Retinopathy - diagnosis Diabetic Retinopathy - epidemiology Disease Early Diagnosis Epidemiology/Health services research Ethnicity Eye Humans Low income groups Mass Screening - methods Medical diagnosis Mydriatics Native peoples Patients Point-of-Care Systems Sensitivity and Specificity Socioeconomic factors Australia Eye Point-of-Care Systems Early Diagnosis Diabetic Retinopathy
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Summary:	IntroductionThe 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 methodsThis 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.ResultsAmong 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.ConclusionThere 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 LSW and HPD are joint first authors.
ISSN:	2052-4897 2052-4897
DOI:	10.1136/bmjdrc-2023-003376