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

• 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
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2023-003376

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.