Evidence map›Paper›PMID 35906419›Full record

ArticleEye (London, England)2023

Validation of diagnostic accuracy of retinal image grading by trained non-ophthalmologist grader for detecting diabetic retinopathy and diabetic macular edema.

Sanil Joseph, Renu P Rajan, Balagiri Sundar, Soundarya Venkatachalam, John H Kempen, Ramasamy Kim

Open access · greenAbstract read
In one paragraph

Article in Eye (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. [Neurodegeneration and retinal changes-A literature overview].Zeitschrift fur Gerontologie und Geriatrie · 2025
    Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 4 countries.

Sanil JosephLions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India.ORCID 0000-0002-8467-5544
Renu P RajanAravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India.
Balagiri SundarAravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India.
Soundarya VenkatachalamLions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India.
John H KempenDepartment of Ophthalmology, , Massachusetts Eye and Ear and Harvard Medical School; Schepens Eye Research Institute, Boston, MA, USA.ORCID 0000-0002-2967-4792
Ramasamy KimAravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India. kim@aravind.org.
Aravind Eye Hospital · INMassachusetts Eye and Ear Infirmary · USThe University of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo validate the fundus image grading results by a trained grader (Non-ophthalmologist) and an ophthalmologist grader for detecting diabetic retinopathy (DR) and diabetic macular oedema (DMO) against fundus examination by a retina specialist (gold standard).

methodsA prospective diagnostic accuracy study was conducted using 2002 non-mydriatic colour fundus images from 1001 patients aged ≥40 years. Using the Aravind Diabetic Retinopathy Evaluation Software (ADRES) images were graded by both a trained non-ophthalmologist grader (grader-1) and an ophthalmologist (grader-2). Sensitivity, specificity, positive predictive value and negative predictive value were calculated for grader-1 and grader-2 against the grading results by an independent retina specialist who performed dilated fundus examination for every study participant.

resultsOut of 1001 patients included, 42% were women and the mean ± (SD) age was 55.8 (8.39) years. For moderate or worse DR, the sensitivity and specificity for grading by grader-1 with respect to the gold standard was 66.9% and 91.0% respectively and the same for the ophthalmologist was 83.6% and 80.3% respectively. For referable DMO, grader-1 and grader-2 had a sensitivity of 74.6% and 85.6% respectively and a specificity of 83.7% and 79.8% respectively.

conclusionsOur results demonstrate good level of accuracy for the fundus image grading performed by a trained non-ophthalmologist which was comparable with the grading by an ophthalmologist. Engaging trained non-ophthalmologists potentially can enhance the efficiency of DR diagnosis using fundus images. Further study with multiple non-ophthalmologist graders is needed to verify the results and strategies to improve agreement for DMO diagnosis are needed.

Indexed as

Diabetes MellitusDiabetic RetinopathyMacular EdemaFemaleHumansMalePhotographyProspective StudiesRetinaSensitivity and Specificity

Identifiers

PMID35906419
PMCPMC10220051
OpenAlexW4288712645

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.