Download PDFPDF
Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Reply to: Comments on "Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China"
    • Helen McAneney, Lecturer Centre for Public Health, Queen's University Belfast
    • Other Contributors:
      • Martha McKenna, Researcher
      • Tingting Chen, Researcher
      • Miguel Angel Vázquez Membrillo, Ophthalmologist
      • Ling Jin, Researcher
      • Wei Xiao, Researcher
      • Tunde Peto, Clnical Professor and Ophthalmologist
      • Mingguang He, Professor
      • Ruth Hogg, Senior Lecturer
      • Nathan Congdon, Professor

    Dear Editor,

    We thank Drs Sabherwal and Sood for their interest in our article.(1) We would like to respond to the interesting points they raise.

    Table 3 presents our analyses of potential predictors of the correct diagnosis by rural doctors of diabetic retinopathy (DR) requiring treatment. Details on a number of the characteristics assessed in this table are presented in the first paragraph of the Results section, but not, as Drs Sabherwal and Sood point out, the proportion having received didactic training. Among the 28 rural doctors, 13 (46.4%) received such training and 15 (53.6%) did not.

    In the Methods, we describe in detail the training received by ophthalmologists in the CREST (Comprehensive Rural Eye Service and Training) program. As described there, only two doctors per hospital (not all of whom examined patients in the current study) could attend the didactic phase of training at the Zhongshan Ophthalmic Center (ZOC). This is due to the limited number of ophthalmologists at a typical rural Chinese county hospital, and the heavy load of clinical duties. For more doctors to have left their facilities for the two-month didactic training would not have been practical. However, all ophthalmologists participating in the CREST network and in the current study received intensive hands-on training by medical retina experts from ZOC at their own facilities, which included the diagnosis and laser treatment of diabetic retinopathy (DR) as well as the u...

    Show More
    Conflict of Interest:
    None declared.
  • 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...

    Show More
    Conflict of Interest:
    None declared.