Teleretinal Screening Appears Effective at Diagnosing Diabetic Retinopathy

Teleretinal screening appears to be an accurate tool to identify patients with diabetic retinopathy (DR), although it is not yet clear whether the same is true for age-related macular degeneration (AMD), according to a new report.

Writing in BMJ Open Ophthalmology, corresponding author Tina Felfeli, MD, of the University of Toronto, and colleagues outlined the results of a review and meta-analysis of 28 articles that considered the diagnostic accuracy of teleretinal screening for the 2 conditions.

The authors explained that new advances in therapy have helped prevent irreversible vision loss in many patients, but they added that the efficacy of such therapies diminishes without early detection and diagnosis.

“Traditional office-based face-to-face examination is effective for screening patients, but there are associated challenges in regions with limited accessibility to resources and eyecare specialists,” the investigators wrote. “Over the past decade with technological improvements, teleretinal screening has been explored as a cost-effective strategy to meet the increasing needs of the population worldwide.”

However, the authors said there has yet to be a meta-analysis that compared human-graded diagnosis with teleretinal screenings. There have been review papers, but they have tended to exclude ungradable images from their analyses, which the authors noted could have the effect of making teleretinal screening appear more accurate than it actually is.

Felfeli and colleagues sought out articles published between 2010 and 2021 that probed the accuracy of teleretinal screening at diagnosing DR and AMD. Compared with face-to-face clinical examination, the investigators found teleretinal screening was highly sensitive and specific at identifying DR.

“We found that teleretinal screening achieved a high accuracy for detection of any DR with a sensitivity of 0.91 (95% confidence interval [CI], 0.82 to 0.96) and specificity of 0.88 (95% CI, 0.74 to 0.95) and referrable DR with a sensitivity of 0.88 (95% CI, 0.81 to 0.93) and specificity of 0.86 (95% CI, 0.79 to 0.90),” they wrote.

“Referrable DR” was defined as a case in which disease severity was “equal to or worse than moderate nonproliferative DR or diabetic macular edema.” Specificity, but not sensitivity, improved slightly for referrable DR when ungradable samples were excluded, they reported.

In the case of AMD, the results were less convincing, in part due to a low number of available studies—just 3.

“Based on our findings, data on AMD are limited but the diagnostic accuracy was calculated to be lower with a sensitivity of 0.71 (95% CI, 0.49 to 0.86) and specificity of 0.88 (95% CI, 0.85 to 0.90),” they wrote.

Felfeli and colleagues said those data were “encouraging,” but were insufficient to fully validate the practice.

The authors also addressed the issue of optical coherence tomography (OCT), which was assessed as an addition to the teleretinal screening program in just one study. In that study, OCT did not appear to provide a significant advantage. However, the investigators said other researchers have come to different conclusions. Thus, additional research is needed to solve the controversy.

Felfeli and colleagues said the limitations to their analysis include heterogeneity in diagnostic criteria and patient populations in the studies referenced.

Looking forward, future research will need to incorporate emerging technologies like artificial intelligence and machine learning, each of which could potentially improve diagnostic accuracy even further, they concluded.

Reference:

Mehraban Far P, Tai F, Ogunbameru A, et al. Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis. BMJ Open Ophthalmol. Published online February 10, 2022. doi:10.1136/bmjophth-2021-000915