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Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System
PURPOSE: To increase the efficiency of retinal image grading, algorithms for automated grading have been developed, such as the IDx‐DR 2.0 device. We aimed to determine the ability of this device, incorporated in clinical work flow, to detect retinopathy in persons with type 2 diabetes. METHODS: Ret...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814834/ https://www.ncbi.nlm.nih.gov/pubmed/29178249 http://dx.doi.org/10.1111/aos.13613 |
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author | van der Heijden, Amber A Abramoff, Michael D Verbraak, Frank van Hecke, Manon V Liem, Albert Nijpels, Giel |
author_facet | van der Heijden, Amber A Abramoff, Michael D Verbraak, Frank van Hecke, Manon V Liem, Albert Nijpels, Giel |
author_sort | van der Heijden, Amber A |
collection | PubMed |
description | PURPOSE: To increase the efficiency of retinal image grading, algorithms for automated grading have been developed, such as the IDx‐DR 2.0 device. We aimed to determine the ability of this device, incorporated in clinical work flow, to detect retinopathy in persons with type 2 diabetes. METHODS: Retinal images of persons treated by the Hoorn Diabetes Care System (DCS) were graded by the IDx‐DR device and independently by three retinal specialists using the International Clinical Diabetic Retinopathy severity scale (ICDR) and EURODIAB criteria. Agreement between specialists was calculated. Results of the IDx‐DR device and experts were compared using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), distinguishing between referable diabetic retinopathy (RDR) and vision‐threatening retinopathy (VTDR). Area under the receiver operating characteristic curve (AUC) was calculated. RESULTS: Of the included 1415 persons, 898 (63.5%) had images of sufficient quality according to the experts and the IDx‐DR device. Referable diabetic retinopathy (RDR) was diagnosed in 22 persons (2.4%) using EURODIAB and 73 persons (8.1%) using ICDR classification. Specific intergrader agreement ranged from 40% to 61%. Sensitivity, specificity, PPV and NPV of IDx‐DR to detect RDR were 91% (95% CI: 0.69–0.98), 84% (95% CI: 0.81–0.86), 12% (95% CI: 0.08–0.18) and 100% (95% CI: 0.99–1.00; EURODIAB) and 68% (95% CI: 0.56–0.79), 86% (95% CI: 0.84–0.88), 30% (95% CI: 0.24–0.38) and 97% (95% CI: 0.95–0.98; ICDR). The AUC was 0.94 (95% CI: 0.88–1.00; EURODIAB) and 0.87 (95% CI: 0.83–0.92; ICDR). For detection of VTDR, sensitivity was lower and specificity was higher compared to RDR. AUC's were comparable. CONCLUSION: Automated grading using the IDx‐DR device for RDR detection is a valid method and can be used in primary care, decreasing the demand on ophthalmologists. |
format | Online Article Text |
id | pubmed-5814834 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-58148342018-02-27 Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System van der Heijden, Amber A Abramoff, Michael D Verbraak, Frank van Hecke, Manon V Liem, Albert Nijpels, Giel Acta Ophthalmol Original Articles PURPOSE: To increase the efficiency of retinal image grading, algorithms for automated grading have been developed, such as the IDx‐DR 2.0 device. We aimed to determine the ability of this device, incorporated in clinical work flow, to detect retinopathy in persons with type 2 diabetes. METHODS: Retinal images of persons treated by the Hoorn Diabetes Care System (DCS) were graded by the IDx‐DR device and independently by three retinal specialists using the International Clinical Diabetic Retinopathy severity scale (ICDR) and EURODIAB criteria. Agreement between specialists was calculated. Results of the IDx‐DR device and experts were compared using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), distinguishing between referable diabetic retinopathy (RDR) and vision‐threatening retinopathy (VTDR). Area under the receiver operating characteristic curve (AUC) was calculated. RESULTS: Of the included 1415 persons, 898 (63.5%) had images of sufficient quality according to the experts and the IDx‐DR device. Referable diabetic retinopathy (RDR) was diagnosed in 22 persons (2.4%) using EURODIAB and 73 persons (8.1%) using ICDR classification. Specific intergrader agreement ranged from 40% to 61%. Sensitivity, specificity, PPV and NPV of IDx‐DR to detect RDR were 91% (95% CI: 0.69–0.98), 84% (95% CI: 0.81–0.86), 12% (95% CI: 0.08–0.18) and 100% (95% CI: 0.99–1.00; EURODIAB) and 68% (95% CI: 0.56–0.79), 86% (95% CI: 0.84–0.88), 30% (95% CI: 0.24–0.38) and 97% (95% CI: 0.95–0.98; ICDR). The AUC was 0.94 (95% CI: 0.88–1.00; EURODIAB) and 0.87 (95% CI: 0.83–0.92; ICDR). For detection of VTDR, sensitivity was lower and specificity was higher compared to RDR. AUC's were comparable. CONCLUSION: Automated grading using the IDx‐DR device for RDR detection is a valid method and can be used in primary care, decreasing the demand on ophthalmologists. John Wiley and Sons Inc. 2017-11-27 2018-02 /pmc/articles/PMC5814834/ /pubmed/29178249 http://dx.doi.org/10.1111/aos.13613 Text en © 2017 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Articles van der Heijden, Amber A Abramoff, Michael D Verbraak, Frank van Hecke, Manon V Liem, Albert Nijpels, Giel Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System |
title | Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System |
title_full | Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System |
title_fullStr | Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System |
title_full_unstemmed | Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System |
title_short | Validation of automated screening for referable diabetic retinopathy with the IDx‐DR device in the Hoorn Diabetes Care System |
title_sort | validation of automated screening for referable diabetic retinopathy with the idx‐dr device in the hoorn diabetes care system |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814834/ https://www.ncbi.nlm.nih.gov/pubmed/29178249 http://dx.doi.org/10.1111/aos.13613 |
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