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Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China
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  • Published on:
    Comments on: "Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China"
    • Shalinder Sabherwal, Ophthalmologist and Head- Public Health for Eye Care Dr. Shroff's Charity Eye Hospital
    • Other Contributors:
      • Ishaana Sood, Trainee- Community Ophthalmology and Research

    Dear Editor,

    We read the article published by McKenna, et al (1) with great interest and laud them on the quality and design of their study. Screening for diabetic retinopathy in rural, low resource settings is the need of the hour, however models which are cost effective, yet provide intensive screening and continuum of care are limited. Keeping this in mind, we feel that there are a few points requiring further clarity in this article.

    The odds-ratio calculated in table 3 displays the significant effect of didactic training on correct diagnosis by rural doctors. However, for the odds-ratio to be calculated, there would have been a comparison group of rural doctors who were not provided didactic training. The numbers of these doctors have not been mentioned, and no details have been provided as to whether they were given any basic level of training related to the program. In the results provided for comparison between rural doctors and the non-medical graders, it has not been made clear whether doctors who had not been provided didactic training were included. In that case, results presented in the study may have been biased towards the non-medical graders.

    In the study, the arbitrator changed the grade for a high percentage of the cases, moreover, 33% of the images were not found to be of adequate quality. Hiring an arbitrator, re-checking the grading and assuring high quality images (2) through standard equipment and trained personnel would drive up...

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    Conflict of Interest:
    None declared.