Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study
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Media type:
E-Article
Title:
Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study
Published in:
BMJ Open, 12 (2022) 9, Seite e059205
Language:
English
DOI:
10.1136/bmjopen-2021-059205
ISSN:
2044-6055
Origination:
Footnote:
Description:
<jats:sec><jats:title>Objectives</jats:title><jats:p>To compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, endocrinologists and one general practitioner), level 2 graders (midlevel ophthalmologists) and level 3 graders (senior ophthalmologists) in Vietnam against a reference standard from the UK and assess the impact of supplementary targeted grader training.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Diagnostic test accuracy study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Secondary care hospitals in Southern Vietnam.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>DR training was delivered to Vietnamese graders in February 2018 by National Health Service (NHS) UK graders. Two-field retinal images (412 patient images) were graded by 14 trained graders in Vietnam between August and October 2018 and then regraded retrospectively by an NHS-certified reference standard UK optometrist (phase I). Further DR training based on phase I results was delivered to graders in November 2019. After training, a randomised subset of images from January to October 2020 (115 patient images) was graded by six of the original cohort (phase II). The reference grader regraded all images from phase I and II retrospectively in masked fashion.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>Sensitivity was calculated at the two different time points, and χ<jats:sup>2</jats:sup>was used to test significance.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In phase I, the sensitivity for detecting any DR for all grader groups in Vietnam was low (41.8–42.2%) and improved in phase II after additional training was delivered (51.3–87.2%). The greatest improvement was seen among level 1 graders (p<0.001), and the lowest improvement was observed among level 3 graders (p=0.326). There was a statistically significant improvement in sensitivity for detecting referable DR and referable diabetic macular oedema between all grader levels. The post-training values ranged from 40.0 to 61.5% (including ungradable images) and 55.6%–90.0% (excluding ungradable images).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This study demonstrates that targeted training interventions can improve accuracy of DR grading. These findings have important implications for improving service delivery in DR screening programmes in low-resource settings.</jats:p></jats:sec>