Evaluation of the prevalence of non-diabetic eye disease detected at first screen from a single region diabetic retinopathy screening program: a cross-sectional cohort study in Auckland, New Zealand.

OBJECTIVES: To evaluate the prevalence of incidental non-diabetic ocular comorbidities detected at first screen in a large diabetic retinopathy (DR) screening programme. DESIGN: Cross-sectional cohort study. SETTING: Single large metropolitan diabetic eye screening programme in Auckland, New Zealand. PARTICIPANTS: Twenty-two thousand seven hundred and seventy-one participants who attended screening from September 2008 to August 2018. RESULTS: Hypertensive retinopathy (HTR) was observed in 14.2% (3236/22 771) participants. Drusen were present in 14.0% participants under the age of 55 years, increasing to 20.5% in those 55 years and older. The prevalence of neovascular age-related macular degeneration (AMD) was 0.5% in participants aged<55 years, 2.4% in participants aged 55-75 years and 16% in participants aged>75 years. Retinal vein occlusion and retinal arterial embolus were prevalent in 0.7% and 0.02%, respectively, in participants aged<55 years, increasing to 2.2% and 0.4%, respectively, in those >75 years. Cataracts were common being present in 37.1% of participants over the age of 75 years. Only 386 individuals (1.7%) were labelled as glaucoma suspects. Geographic atrophy, epiretinal membrane, choroidal nevi and posterior capsular opacification had an increased prevalence in older individuals. CONCLUSIONS: Our data suggest that AMD, HTR and cataracts are routinely detected during DR screening. The incorporation of the detection of these ocular comorbidities during DR screening provide opportunities for patients to modify risk factors (smoking cessation and diet for AMD, blood pressure for HTR) and allow access to cataract surgery.

Diabetic retinopathy screening using deep neural network.

IMPORTANCE: There is a burgeoning interest in the use of deep neural network in diabetic retinal screening. BACKGROUND: To determine whether a deep neural network could satisfactorily detect diabetic retinopathy that requires referral to an ophthalmologist from a local diabetic retinal screening programme and an international database. DESIGN: Retrospective audit. PARTICIPANTS: Diabetic retinal photos from Otago database photographed during October 2016 (485 photos), and 1200 photos from Messidor international database. METHODS: Receiver operating characteristic curve to illustrate the ability of a deep neural network to identify referable diabetic retinopathy (moderate or worse diabetic retinopathy or exudates within one disc diameter of the fovea). MAIN OUTCOME MEASURES: Area under the receiver operating characteristic curve, sensitivity and specificity. RESULTS: For detecting referable diabetic retinopathy, the deep neural network had an area under receiver operating characteristic curve of 0.901 (95% confidence interval 0.807-0.995), with 84.6% sensitivity and 79.7% specificity for Otago and 0.980 (95% confidence interval 0.973-0.986), with 96.0% sensitivity and 90.0% specificity for Messidor. CONCLUSIONS AND RELEVANCE: This study has shown that a deep neural network can detect referable diabetic retinopathy with sensitivities and specificities close to or better than 80% from both an international and a domestic (New Zealand) database. We believe that deep neural networks can be integrated into community screening once they can successfully detect both diabetic retinopathy and diabetic macular oedema.

Is screening for congenital colour vision deficiency in school students worthwhile? A review.

This review analyses the literature on screening for congenital colour vision deficiency in school students, which predominantly uses the Ishihara test. The review was framed with respect to the established Wilson and Jungner criteria for screening programs. These criteria relate to the characteristics of the condition concerned, the performance of the screening test, the existence of treatment options and the performance of screening programs. The literature reviewed suggests that congenital colour vision deficiency has not been shown to increase risk of road traffic crashes and is not a preclusion to driver licensing in most developed countries. The occurrence of congenital colour vision deficiency has been used to limit entry into certain occupations; however, the value of screening school students with regard to occupational preclusion is questionable. Stronger evidence exists indicating no association between congenital colour vision deficiency and level of educational achievement. Studies showing any association between congenital colour vision deficiency and other health and lifestyle impacts were rare. The most commonly used screening test (using Ishihara pseudoisochromatic plates) performs well with respect to detecting red-green colour vision deficiencies. Finally, the only interventions we identified for congenital colour vision deficiency were management ones around the availability of specific tinted lenses and computer programs to aid colour perception in certain tasks. Given this picture, the weight of evidence appears to be in favour of not adopting (or discontinuing) routine colour vision screening programs for school students; however, it may be worthwhile for a career advisor to refer school students to an optometrist or ophthalmologist for colour vision screening, upon expression of interest in an occupation where normal colour vision is either particularly desirable or is a regulatory requirement.

Accuracy of visual acuity testing in New Zealand primary health care.

AIM: To determine if visual acuity is tested reliably in primary health care in New Zealand. METHODS: Fifteen to 26 'eyes' from seven participants were tested in the Eye Department of Dunedin Hospital under standardised conditions; and across 17 centres in nine general practices and the Emergency Department of Dunedin Hospital for comparison. Variables including lighting and distance were measured; chart type and centre conditions were recorded. RESULTS: Eleven centres (65%) produced visual acuity scores that were inconsistent with the Eye Department, where 10 (59%) of them produced worse visual acuity scores and one centre (6%) produced better visual acuity score. Ten centres (59%) did not meet New Zealand Transport Agency standards of adequate illumination of greater than 500 lux. Ten centres (59%) failed to have their charts at the specified distance. CONCLUSION: There were inconsistencies in visual acuity testing in primary health care in Dunedin, New Zealand which may be related to the overall poor compliance with lighting and distance standards. These factors are potentially easily modifiable and their change should lead to improvements in visual acuity measurements.