Beyond retinal screening: digital imaging in the assessment and follow-up of XXXX with @entity6 .

@entity1 @entity6 @entity989
Many screening methods are available for detecting @entity6 . However, once @entity1 develop @entity989 , it is unclear as to what method should be used for their review. We describe a novel and integrated system for the screening and treatment of @entity6 using high street optometrists for primary screening and digital imaging as a secondary screening tool, with referral to a joint retinal clinic only where ophthalmological intervention may be required. Of 3586 @entity1 screened by optometrists, 328 were classified as having moderate/severe @entity989 or @entity6 . @entity1 with @entity989 (1% of the total) were recalled directly to the joint retinal clinic. A consecutive sample (281) of these @entity1 , together with a further 100 classified by the optometrists as having no or background @entity989 were compared using digital images and standard 35 mm colour transparencies. These, together with the original optometrist reports, were reviewed independently and individually by an ophthalmologist. A further sample of 124 @entity1 who had undergone both digital imaging and ophthalmologist slit-lamp examination were also compared. Comparison of 35 mm colour transparencies with optometrist reports showed the latter had a sensitivity for detecting sight-threatening @entity989 (STR) of 62%, a specificity of 84%, and a kappa score of 0.62. The results for digital images were 90%, 97%, and 0.90, respectively, although the extent of @entity989 was under-reported in 10 @entity1 . With ophthalmologist slit-lamp examination as the gold standard, the sensitivity of digital imaging was 90% with a substantial level of agreement between them (kappa 0.61). We conclude that digital images provide an efficient method for the follow-up of @entity1 with established or previously treated @entity989 .
