title: Imager evaluation of diabetic retinopathy at the time of imaging in a telemedicine program.
abstract: OBJECTIVE
  To evaluate the ability of certified retinal imagers to identify presence versus absence of sight-threatening diabetic retinopathy (stDR) (moderate nonproliferative diabetic retinopathy or worse or diabetic macular edema) at the time of retinal imaging in a telemedicine program.
  
  
  METHODS
  Diabetic patients in a primary care setting or specialty diabetes clinic received Joslin Vision Network protocol retinal imaging as part of their care. Trained nonphysician imagers graded the presence versus absence of stDR at the time of imaging. These gradings were compared with masked gradings of certified readers.
  
  
  RESULTS
  Of 158 patients (316 eyes) imaged, all cases of stDR (42 eyes [13%]) were identified by the imagers at the time of imaging. Six eyes with mild nonproliferative diabetic retinopathy were graded by the imagers to have stDR (sensitivity 1.00, 95% CI 0.90-1.00; specificity 0.97, 0.94-0.99).
  
  
  CONCLUSIONS
  Appropriately trained imagers can accurately identify stDR at the time of imaging.
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Cavallerano
authors.forename: Paolo S
authors.initials: PS
authors.lastname: Silva
authors.forename: Ann M
authors.initials: AM
authors.lastname: Tolson
authors.forename: Taniya
authors.initials: T
authors.lastname: Francis
authors.forename: Dorothy
authors.initials: D
authors.lastname: Tolls
authors.forename: Bina
authors.initials: B
authors.lastname: Patel
authors.forename: Sharon
authors.initials: S
authors.lastname: Eagan
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Aiello
authors.forename: Lloyd P
authors.initials: LP
authors.lastname: Aiello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000473:pathology*; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017216:Telemedicine; D055815:Young Adult