Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2024; 15(2): 251-259
Published online Feb 15, 2024. doi: 10.4239/wjd.v15.i2.251
Application of non-mydriatic fundus photography-assisted telemedicine in diabetic retinopathy screening
Wan Zhou, Xiao-Jing Yuan, Jie Li, Wei Wang, Hao-Qiang Zhang, Yuan-Yuan Hu, Shan-Dong Ye
Wan Zhou, Xiao-Jing Yuan, Wei Wang, Hao-Qiang Zhang, Yuan-Yuan Hu, Shan-Dong Ye, Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Jie Li, Department of Endocrinology, Anhui Provincial Hospital, Affiliated to Anhui Medical University, Hefei 230001, Anhui Province, China
Co-corresponding authors: Wan Zhou and Wei Wang.
Author contributions: Yuan XJ and Li J collected and analyzed the data; Ye SD reviewed and edited the manuscript; Zhang HQ and Hu YY performed the statistical analyses and interpreted experimental results. Wang W and Zhou W contributed equally to this article, they are co-corresponding authors of this manuscript. Zhou W designed the research, analyzed the data, and wrote the manuscript; Wang W reviewed and edited the manuscript, and revised the manuscript. Zhou W is the principal corresponding author and have been responsible for the submission of the manuscript, communication during the peer review and publication processes, providing ethics committee approvals, clinical registration documents, and conflict of interest forms and statements.
Supported by the Project of National Natural Science Foundation of China, No. 82270863; Major Project of Anhui Provincial University Research Program, No. 2023AH040400; and Joint Fund for Medical Artificial Intelligence, No. MAI2023Q026.
Institutional review board statement: This study was conducted in accordance with the tenets of the World Medical Association’s Declaration of Helsinki and had been approved by the ethics committee of the First Affiliated Hospital of University of Science and Technology of China.
Informed consent statement: All the subjects signed informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wan Zhou, PhD, Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230001, Anhui Province, China. zwan@ustc.edu.cn
Received: November 23, 2023
Peer-review started: November 23, 2023
First decision: December 8, 2023
Revised: December 10, 2023
Accepted: January 12, 2024
Article in press: January 12, 2024
Published online: February 15, 2024
Processing time: 73 Days and 0.6 Hours
Abstract
BACKGROUND

Early screening and accurate staging of diabetic retinopathy (DR) can reduce blindness risk in type 2 diabetes patients. DR’s complex pathogenesis involves many factors, making ophthalmologist screening alone insufficient for prevention and treatment. Often, endocrinologists are the first to see diabetic patients and thus should screen for retinopathy for early intervention.

AIM

To explore the efficacy of non-mydriatic fundus photography (NMFP)-enhanced telemedicine in assessing DR and its various stages.

METHODS

This retrospective study incorporated findings from an analysis of 93 diabetic patients, examining both NMFP-assisted telemedicine and fundus fluorescein angiography (FFA). It focused on assessing the concordance in DR detection between these two methodologies. Additionally, receiver operating characteristic (ROC) curves were generated to determine the optimal sensitivity and specificity of NMFP-assisted telemedicine, using FFA outcomes as the standard benchmark.

RESULTS

In the context of DR diagnosis and staging, the kappa coefficients for NMFP-assisted telemedicine and FFA were recorded at 0.775 and 0.689 respectively, indicating substantial intermethod agreement. Moreover, the NMFP-assisted telemedicine’s predictive accuracy for positive FFA outcomes, as denoted by the area under the ROC curve, was remarkably high at 0.955, within a confidence interval of 0.914 to 0.995 and a statistically significant P-value of less than 0.001. This predictive model exhibited a specificity of 100%, a sensitivity of 90.9%, and a Youden index of 0.909.

CONCLUSION

NMFP-assisted telemedicine represents a pragmatic, objective, and precise modality for fundus examination, particularly applicable in the context of endocrinology inpatient care and primary healthcare settings for diabetic patients. Its implementation in these scenarios is of paramount significance, enhancing the clinical accuracy in the diagnosis and therapeutic management of DR. This methodology not only streamlines patient evaluation but also contributes substantially to the optimization of clinical outcomes in DR management.

Keywords: Diabetes; Diabetic retinopathy; Non-mydriatic fundus photography-assisted telemedicine; Fundus fluorescein angiography

Core Tip: There is a high consistency between non-mydriatic fundus photography (NMFP)-assisted telemedicine and fundus fluorescein angiography (FFA) techniques. The area under the curve of NMFP-assisted telemedicine results for predicting a positive result from FFA was 0.955. The specificity, sensitivity, and a Youden index of NMFP-assisted telemedicine were 100%, 90.9% and 0.909, respectively. The NMFP-assisted telemedicine has a great significant value in the clinical diagnosis and treatment of diabetic retinopathy.