Comparison of Photographic Screening Methods for Diabetic Retinopathy – A Meta-analysis

ABSTRACT

Introduction

Diabetic Retinopathy (DR) is a leading cause of irreversible visual impairment and blindness in both developed and developing countries. Although the merits of DR screening are well recognized, significant variations in screening practices including imaging modality still exists.

Purpose

To evaluate and compare the sensitivity and specificity of mydriatic and non-mydriatic photographic screening methods using 7-Field fundus photography or dilated fundus examination (DFE) by an ophthalmologist as reference standard.

Methods

A systematic review using PRISMA Guidelines was conducted by online search of MEDLINE, Web of Science, and other repositories of all available studies from 1990 until 2019. A total of 62 studies were included in the meta-analysis from a total of 406 suitable abstracts screened and 95 articles reviewed in full. Data were collected using a standardized extraction form independently, with all authors masked to others’ search results.

Results

For the detection of any DR (ADR), sensitivity ranged from 81% with single field to a maximum of 99% for 4–7 fields and wide-angle images. For detection of referable DR (RDR) sensitivity ranged from 76% for single field to 93% for wide-angle photography. Specificity was lowest at 91% for wide-angle images and greatest at 99% for three field photography. Study heterogeneity was noted to be significant, which was partly attributed to the range of DR classification between studies.

Conclusions

The sensitivity and specificity of DR screening are positively associated with number of photographic fields. Pooled estimates suggest non-mydriatic two-field photography may be sufficient for screening detection of ADR and RDR.

KEYWORDS:

• Epidemiology
• diabetic retinopathy
• sensitivity
• specificity
• screening

Acknowledgments

CERA receives Operational Infrastructure Support from the Victorian Government.

Dr. William Yan and Dr. Myra McGuinness are the guarantors of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Statement of contributions

Dr. William Yan, Dr. Rahul Chakrabarti and Ms. Kathy Fotis researched eligible studies in the literature under the supervision of Prof. Robert Finger. Dr. William Yan extracted data from the eligible studies for analysis. Dr. Myra McGuinness provided the statistical analysis. Dr. William Yan and Dr. Myra McGuinness wrote the manuscript and provided data interpretation. Prof. Robert Finger and Dr. Rahul Chakrabarti reviewed and edited the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2022.2065311.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.