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
ARTICLE HIGHLIGHTS
Research background

Prompt detection and precise classification of diabetic retinopathy (DR) in individuals with type 2 diabetes can lessen the likelihood of blindness. Given DR’s intricate causes, relying solely on ophthalmologist examinations may not be enough for effective prevention and treatment. Since endocrinologists frequently encounter diabetic patients initially, they play a crucial role in early DR screening and intervention.

Research motivation

We endeavored to offer fresh perspectives on the screening approaches for DR.

Research objectives

This study investigates the effectiveness of telemedicine enhanced by non-mydriatic fundus photography (NMFP) in evaluating DR and its different stages.

Research methods

This study retrospectively analyzed 93 diabetic patients, comparing NMFP-assisted telemedicine with fundus fluorescein angiography (FFA) in detecting DR. It aimed to evaluate the agreement between these methods and used receiver operating characteristic (ROC) curves to assess the accuracy of NMFP against the FFA benchmark.

Research results

In diagnosing and staging DR, NMFP-assisted telemedicine and FFA showed substantial agreement with kappa coefficients of 0.775 and 0.689, respectively. NMFP’s predictive accuracy for positive FFA outcomes, indicated by a ROC curve area of 0.955 (confidence interval 0.914 to 0.995) and a P-value < 0.001, was high. The model demonstrated 100% specificity, 90.9% sensitivity, and a Youden index of 0.909.

Research conclusions

This study introduces NMFP-assisted telemedicine as a practical, accurate method for examining the fundus, especially suitable for endocrinology inpatient care and primary healthcare for diabetic patients. Its use in these settings is crucial for improving the accuracy of diagnosing and treating DR. This approach simplifies patient assessments and significantly improves clinical results in DR management. The new theories proposed by this study include the importance of integrating NMFP-assisted telemedicine into endocrinology and primary healthcare for enhanced DR management. The new method proposed is the application of NMFP-assisted telemedicine itself for fundus examination in diabetic patients.

Research perspectives

Future research should focus on expanding the use of NMFP-assisted telemedicine in various healthcare settings for DR management, and conducting larger, long-term studies to evaluate its effectiveness. Additionally, exploring technological improvements and interdisciplinary collaborations can enhance the accuracy and impact of this approach in DR diagnosis and treatment.