![]() Providing appropriate training to photographers is of paramount importance, and with enough practice, high levels of competence can be achieved by those taking imaging regularly. Digital retinal imaging has been widely practiced and an accurate method for DRS. Many studies have shown that control of risk factors, early DR screening (DRS) and appropriate treatment can reduce the risk of blindness and visual impairment due to DR. DR is a leading cause of blindness among the young and middle-aged adults in most of the high-income countries (HIC). A pooled meta-analysis using population-based studies conducted in the USA, Australia, Europe and Asia showed that the prevalence of any DR in PwDM aged 20 to 70 years was 34.6% (95% CI 34.5–34.8%): proliferative DR affected 6.96% (95% CI 6.87–7.04%) and sight-threatening DR (STDR) affected 10.2% (95% CI 10.1–10.3%), globally translating to approximately 28 million PwDM affected by STDR. Diabetic retinopathy (DR) is a common microvascular complication of DM caused by chronic hyperglycaemia. This is exacerbated by weak health systems coupled with slow economic development. The greatest impact affects low- and middle-income countries (LMIC) (overall increase 69%) due to ageing population, obesity and sedentary life style. The International Diabetes Federation (IDF) estimated that there were 425 million people with DM (PwDM) in the world in 2017 which is projected to increase to 629 million by 2045. Conducting more context-specific DRS validation studies in low-income and non-ophthalmic settings can be recommended.ĭiabetes mellitus (DM) is one of the most prevalent non-communicable diseases and has significant impacts on health systems. There was insufficient evidence in primary studies to draw firm conclusions on how graders’ background influences DTA. Non-mydriatic two-field strategy could be a more pragmatic approach in starting DRS programmes for facility-based PwDM in low-income settings, with dilatation of the pupils of those who have ungradable images. The highest DTA (sensitivity 90%, 95% CI 88–91% specificity 95%, 95% CI 94–96%) was observed when screening was delivered at secondary/tertiary level clinics. Overall, there was no difference in sensitivity between non-mydriatic and mydriatic methods (86%, 95% CI 85–87) after exclusion of ungradable images. The highest specificity was observed in greater than two field methods (94%, 95% CI 93–96%) where mydriasis did not affect specificity. The highest sensitivity was observed in the mydriatic greater than two field strategy (92%, 95% CI 90–94%). Twenty-six studies were included in the review, and 21 studies, mostly from high-income settings (18/21, 85.7%), were included in the meta-analysis. Six thousand six hundred forty-six titles and abstracts were retrieved, and data were extracted from 122 potentially eligible full reports. We also examined the effect on detection from using different combinations of retinal fields, pupil status, index test graders and setting. The meta-analysis included studies which measured DTA of detecting any level of DR. The DTA of each screening method was derived after exclusion of ungradable images and considering the eye as the unit of analysis. Summary estimates of different sub-groups were calculated using DTA values weighted according to the sample size. We conducted a systematic literature search to identify clinic-based studies on DRS using digital retinal imaging of people with DM (PwDM). The aim of this review is to evaluate how different characteristics of the DR screening (DRS) test impact on diagnostic test accuracy (DTA) and its relevance to a low-income setting. Digital retinal imaging has become a preferred choice as it enables higher coverage of screening. ![]() Visual impairment from diabetic retinopathy (DR) is an increasing global public health concern, which is preventable with screening and early treatment.
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