Diabetic Retinopathy Screening Using Non-Mydriatic Fundus Camera in Primary Health Care Settings – A Multicenter Study from Saudi Arabia

Abstract

Background

Screening of diabetic retinopathy (DR) using the current digital imaging facilities in a primary health care setting is still in its early stages in Saudi Arabia. This study aims to reduce the risk of vision impairment and blindness among known diabetic people through early identification by general practitioners (GP) in a primary health care setting in Saudi Arabia. The objective of this study was to evaluate the accuracy of diabetic retinopathy (DR) detection by general practitioners (GPs) by comparing the agreement of DR assessment between GPs and ophthalmologists' assessment as a gold standard.

Methods

A hospital-based, six-month cross-sectional study was conducted, and the participants were type 2 diabetic adults from the diabetic registries of seven rural PHCs, in Saudi Arabia. After medical examination, the participants were then evaluated by fundus photography using a non-mydriatic fundus camera without medication for mydriasis. Presence or absence of DR was graded by the trained GPs in the PHCs and then compared with the grading of an ophthalmologist which was taken as a reference or a gold standard.

Results

A total of 899 diabetic patients were included, and the mean age of the patients was 64.89 ± 11.01 years. The evaluation by the GPs had a sensitivity of 80.69 [95% CI 74.8–85.4]; specificity of 92.23 [88.7–96.3]; positive predictive value, 74.1 [70.4–77.0]; negative predictive value, 73.34 [70.6–77.9]; and an accuracy of 84.57 [81.8–89.88]. For the consensus of agreement the adjusted kappa coefficient was from 0.74 to 0.92 for the DR.

Conclusion

This study demonstrates that trained GPs in rural health centers are able to provide reliable detection results of DR from fundus photographs. The study highlights the need for early DR screening programs in the rural areas of Saudi Arabia to facilitate early identification of the condition and to lessen impact of blindness due to diabetes.

Keywords:

• diabetic retinopathy
• rural health
• primary health care
• diabetes mellitus
• non mydriatic camera
• retinal imaging
• fundus photography
• primary health care
• diabetes
• family health
• ophthalmology
• prevention
• screening

Abbreviations

AI, artificial intelligence; DR, diabetic retinopathy; GP, general practitioners; MA, microaneurysms; NPG, non-physician graders; PHC, primary health care; SDCPG, Saudi Diabetes Clinical Practice Guidelines; WHO, World Health Organization.

Data Sharing Statement

Any data and materials related to this study are available on a reasonable request.

Ethical Approval

Received on review and acceptance from the Institutional Research board (IRB) at Majmaah University, Saudi Arabia (MRIEC07/BHSRC1084), and this study adhered to the guidelines of the Declaration of Helsinki.

Acknowledgments

The author would like to acknowledge the primary health centers in Majmaah and is grateful to King Khalid Hospital for their active participation and helping to conduct this research. The author also extends his appreciation to the Deanship of Scientific Research at Majmaah University for the support provided for this work.

Disclosure

The author involved in the current study does not declare any competing conflict of interest.

Additional information

Funding

No fund or sponsorship in any form was obtained from any organization for carrying out this study.