JMIR Publications

ABSTRACT

Background:

Training parameters to calibrate and standardize the training of non-ophthalmologist readers for safe DR interpretation in a screening program are not readily available in the litterature.

Objective:

To evaluate the quality of intervention and learning curve in the training of two diabetic retinopathy nurse readers in a hospital-based tele-screening program as Level 1 (presence/absence of DR) and Level 2 (up to moderate DR) readers.

Methods:

This retrospective inter-observer study, measures the reliability of the assessment of the presence of any DR by Level 1 readers in 266 patients and that of the identification of patients at risk of vision loss from DR by Level 2 readers in 559 more patients. The learning curve, sensitivity and specificity of the readings are evaluated using a group consensus gold standard.

Results:

Almost perfect agreement is measured in identifying the presence of DR in both Level 1 readers (k = 0.86 and 0.80)]) and in identifying referable DR by Level 2 readers, (k = 0.80 and 0.83) ; at least substantial agreement is measured in the Level 2 readers for macular edema (k = 0.79 and 0.88) for all eyes. Good screening threshold sensitivities and specificities are obtained in all Level readers, with sensitivities of 90.6% and 96.9% and specificities of 95.1% and 85.1% for Level 1 readers and with sensitivities of 86.8% and 91.2% and specificities of 91.7% and 97.0% for Level 2 readers. This performance is achieved immediately after training and remained stable throughout the study.

Conclusions:

Notwithstanding the small number of trained readers, this study validates the screening performance of Level 1 and Level 2 DR readers within this training program emphasizing practical experience and allows the establishment of an ongoing assessment clinic. It highlights the importance of supervised hands-on experience and may help set parameters to further calibrate the training of DR readers for safe screening programs. Clinical Trial: This study is approved by the Institutional Suitability committee, the Scientific Evaluation Committee and the Research Ethics Committee of the Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal , Montreal, Québec, Canada where it was conducted (US Federal Wide Assurance numbers FWA00001935 and IRB00002087).