@article {1647900,
	title = {Validation of diagnostic accuracy of retinal image grading by trained non-ophthalmologist grader for detecting diabetic retinopathy and diabetic macular edema},
	journal = {Eye (Lond)},
	volume = {37},
	number = {8},
	year = {2023},
	month = {2023 Jun},
	pages = {1577-1582},
	abstract = {PURPOSE: To 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). METHODS: A 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. RESULTS: Out of 1001 patients included, 42\% were women and the mean {\textpm} (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. CONCLUSIONS: Our 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.},
	keywords = {Diabetes Mellitus, Diabetic Retinopathy, Female, Humans, Macular Edema, Male, Photography, Prospective Studies, Retina, Sensitivity and Specificity},
	issn = {1476-5454},
	doi = {10.1038/s41433-022-02190-4},
	author = {Joseph, Sanil and Rajan, Renu P and Sundar, Balagiri and Venkatachalam, Soundarya and Kempen, John H and Kim, Ramasamy}
}
