Faculty Collaboration Database

Automated analysis of retinal images for detection of referable diabetic retinopathy. JAMA Ophthalmol 2013 Mar;131(3):351-7

Date

03/16/2013

Pubmed ID

23494039

DOI

10.1001/jamaophthalmol.2013.1743

Scopus ID

2-s2.0-84875180389 (requires institutional sign-in at Scopus site)   311 Citations

Abstract

IMPORTANCE: The diagnostic accuracy of computer detection programs has been reported to be comparable to that of specialists and expert readers, but no computer detection programs have been validated in an independent cohort using an internationally recognized diabetic retinopathy (DR) standard.

OBJECTIVE: To determine the sensitivity and specificity of the Iowa Detection Program (IDP) to detect referable diabetic retinopathy (RDR).

DESIGN AND SETTING: In primary care DR clinics in France, from January 1, 2005, through December 31, 2010, patients were photographed consecutively, and retinal color images were graded for retinopathy severity according to the International Clinical Diabetic Retinopathy scale and macular edema by 3 masked independent retinal specialists and regraded with adjudication until consensus. The IDP analyzed the same images at a predetermined and fixed set point. We defined RDR as more than mild nonproliferative retinopathy and/or macular edema.

PARTICIPANTS: A total of 874 people with diabetes at risk for DR.

MAIN OUTCOME MEASURES: Sensitivity and specificity of the IDP to detect RDR, area under the receiver operating characteristic curve, sensitivity and specificity of the retinal specialists' readings, and mean interobserver difference (κ).

RESULTS: The RDR prevalence was 21.7% (95% CI, 19.0%-24.5%). The IDP sensitivity was 96.8% (95% CI, 94.4%-99.3%) and specificity was 59.4% (95% CI, 55.7%-63.0%), corresponding to 6 of 874 false-negative results (none met treatment criteria). The area under the receiver operating characteristic curve was 0.937 (95% CI, 0.916-0.959). Before adjudication and consensus, the sensitivity/specificity of the retinal specialists were 0.80/0.98, 0.71/1.00, and 0.91/0.95, and the mean intergrader κ was 0.822.

CONCLUSIONS: The IDP has high sensitivity and specificity to detect RDR. Computer analysis of retinal photographs for DR and automated detection of RDR can be implemented safely into the DR screening pipeline, potentially improving access to screening and health care productivity and reducing visual loss through early treatment.

Author List

Abràmoff MD, Folk JC, Han DP, Walker JD, Williams DF, Russell SR, Massin P, Cochener B, Gain P, Tang L, Lamard M, Moga DC, Quellec G, Niemeijer M

MESH terms used to index this publication - Major topics in bold

Area Under Curve
Diabetic Retinopathy
False Negative Reactions
Female
Humans
Image Interpretation, Computer-Assisted
Macular Edema
Male
Middle Aged
Observer Variation
Ophthalmology
Photography
Predictive Value of Tests
ROC Curve
Referral and Consultation
Reproducibility of Results
Retina
Sensitivity and Specificity