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Addressing Technical Failures in a Diabetic Retinopathy Screening Program.

Ian Gerard Brennan1, Stephen R Kelly1, Edel McBride2

  • 1Diabetic RetinaScreen, National Screening Service, Health Service Executive, Dublin, Ireland.

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Technical failures in diabetic retinopathy screening are often caused by cataracts. Identifying patient factors associated with these failures can improve screening outcomes and reduce diagnostic delays.

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Area of Science:

  • Ophthalmology
  • Public Health
  • Medical Imaging

Background:

  • Diabetic retinopathy (DR) is a leading cause of preventable blindness.
  • Early detection through retinal digital photography is crucial for timely intervention.
  • Technical failures (TF) in digital retinal imaging can delay diagnosis and treatment of sight-threatening DR.

Purpose of the Study:

  • To identify factors associated with technical failures (TF) in the Irish National Diabetic Retina Screening (DRS) program.
  • To investigate patient and photographer factors contributing to ungradable retinal images.
  • To inform interventions aimed at reducing TF and improving DR screening efficiency.

Main Methods:

  • Analysis of 366,528 screening appointments from 104,407 patients (2018-2022).
  • Mixed-effects logistic regression models used for primary analysis of TF factors.
  • Detailed review of a subset of TF cases to determine specific causes.

Main Results:

  • The overall TF rate was 4.9%.
  • Factors significantly associated with TF included diabetes type and duration, pupil dilation status, and camera lens artefacts.
  • Optically dense cataracts were identified as the primary cause of TF, accounting for over 50% of cases.

Conclusions:

  • Cataracts are the main contributor to technical failures in the Irish DRS program.
  • Understanding patient-level factors associated with TF is key to developing targeted interventions.
  • Reducing TF can minimize delays in DR diagnosis and treatment, improving patient outcomes.