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The endocrinologists also had difficulties in grading DR with several stage 3 NPDR diseases being under classified as stage 2.
The observers had to note the following points for each set: 1) image quality of the individual images as well as reconstructed mosaics; 2) confidence degree for screening and grading DR depending on the quality of the images.
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The prevalence of diabetic retinopathy (DR) was higher in pubertal than in prepubertal patients, both for any grade DR (71 vs. 40%, P = 0.002) and for mild or more severe DR (P = 0.005).
A panel of ophthalmologists graded DR severity in retinal photographs included in the development and internal validation data sets (n = 71,043); a reference standard grading was assigned once three graders achieved consistent grading outcomes.
Study participants were not asked to grade DR; the sensitivity of mild and moderate NPDR was assessed in terms of detection of retinopathy in images with mild and moderate NPDR, respectively.
All tissue specimens from primary tumours and metastatic lesions were verified by histology to confirm diagnosis, histological type and tumour grade (Dr QingKai Yu, Pathologist, Director of Department of Pathology, Henan Tumour Hospital, China).
Studies in other countries have shown that optometrists are able to detect and grade DR [ 24] and specially trained optometrists perform well when screening for STDR (sensitivity 73%-97 73%-97pecificity 83%-99%) [ 25- 29].
Regarding the grading of DR, there is evidence that color photography is superior to clinical fundoscopy alone (14, 24, 25).
For grading of DR level, similar levels of agreement were found for Optomap and 7-field photography.
Grading of DR and clinically significant macular edema (CSME) from mydriatic ETDRS 7-field stereo photography was compared with grading obtained by Optomap Panoramic 200 SLO images.
Note: The gold-standard for grading of DR, AMD and optic disc changes is based on retinal photographs and not clinical assessment.
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