Abstract
Aims
To summarize the effects of centralization of diabetic fundus photograph interpretation into a virtual reading center.
Methods
In 2016 Kaiser Permanente Northern California, a large, membership-based health plan with an ethnically and racially diverse population, centralized diabetic retinopathy screening into a virtual reading center. Retina screens were based on single field, 45-degree fundus photographs. We compared the accuracy of photography interpretation the year before centralization to the year after using masked reads performed by retina specialists of 1000 randomly selected screens from each time period.
Results
In all, 1902 patient screens with adequate quality images were included in the primary analysis. Images from pre-centralization screens were largely read by ophthalmologists (76.2%), while screens post-centralization were mainly read by optometrists (84.6%). Despite being interpreted by readers with lower levels of professional training, the sensitivity of screening increased from 43.9% (95% CI 38.0–49.8%) to 66.0% (95% CI 60.5–71.4%).
Conclusion
A move to a centralized virtual reading center was associated with improved accuracy of diabetic retinopathy screening.
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Acknowledgements
RBM participated in study design, served as study coordinator, researched the data, and assisted in writing manuscript. SWS participated in reading fundus images, and reviewed manuscript. CC participated in study design, researched data, provided statistical analysis and assisted in writing the manuscript. DT participated in study design, read fundus images, researched the data and wrote the manuscript. DT is the guarantor of this work and takes responsibility for the integrity of the data and accuracy of the data analysis. The study was supported by the Kaiser Permanente (Grant No. RNG 809486) Division of Research 2018 Community Benefit Grant.
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The research was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The Kaiser Foundation Research Institutional Review Board approved the study.
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Our study is a retrospective, anonymized, data only project. All results are reported in aggregate. This format was approved by the local IRB and did not require informed consent.
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Melles, R.B., Conell, C., Siegner, S.W. et al. Diabetic retinopathy screening using a virtual reading center. Acta Diabetol 57, 183–188 (2020). https://doi.org/10.1007/s00592-019-01392-9
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DOI: https://doi.org/10.1007/s00592-019-01392-9