Recognition of diabetic retinopathy in retinal photographs can be improved with a basic education programme


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Abstract

Every person with diabetes in the United Kingdom should have access to annual digital retinal photographs to screen for diabetic retinopathy. Our experience is that medical students, junior hospital doctors and general practitioners are all concerned that they may not be able to interpret these pictures. We examined several different groups to determine their baseline level of knowledge and to see if minimal education could improve their ability to diagnose diabetic retinopathy in retinal photographs.Twenty-eight fourth-year medical students, 16 foundation year 1 (FY1) doctors, 17 core medical trainees/specialist medical registrars and 12 general practitioners were each shown 20 retinal images. All images were 45° macula centred retinal photographs: 10 normal and 10 with diabetic retinopathy. Participants were asked to classify them as normal or abnormal (diabetic retinopathy present) both before and after a five-minute educational session on the lesions seen in diabetic retinopathy.The results showed that 3.6% (1/28) of medical students pre-education and 25% (7/28) post-education achieved a sensitivity >80% and specificity >95%, as per national guidelines. Mean sensitivities improved from 78% to 89% for fourth-year medical students, 71.9% to 83.1% for FY1 doctors, 88% to 91% for core medical trainees/specialist registrars and 61% to 82% for general practitioners.Health care professionals are increasingly able to access retinal images and are concerned that they may not be able to interpret these images. While the baseline ability of these groups to screen for diabetic retinopathy was variable, their accuracy was significantly improved with a simple and brief intervention. These results suggest that all participants should revise their knowledge on this topic and others should think about doing so.

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