{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T21:35:30Z","timestamp":1778535330664,"version":"3.51.4"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T00:00:00Z","timestamp":1724457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T00:00:00Z","timestamp":1724457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-024-01222-5","type":"journal-article","created":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T14:02:18Z","timestamp":1724508138000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Cost-effectiveness of incorporating self-imaging optical coherence tomography into fundus photography-based diabetic retinopathy screening"],"prefix":"10.1038","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8170-0265","authenticated-orcid":false,"given":"Zitian","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaotong","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shida","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3167-0851","authenticated-orcid":false,"given":"Wenyong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyan","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengchi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0914-7864","authenticated-orcid":false,"given":"Yingfeng","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,24]]},"reference":[{"key":"1222_CR1","doi-asserted-by":"publisher","first-page":"963","DOI":"10.2337\/dc17-1962","volume":"41","author":"C Bommer","year":"2018","unstructured":"Bommer, C. et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diab. Care 41, 963\u2013970 (2018).","journal-title":"Diab. Care"},{"key":"1222_CR2","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1097\/APO.0000000000000267","volume":"8","author":"TY Wong","year":"2019","unstructured":"Wong, T. Y. & Sabanayagam, C. The War on diabetic retinopathy: where are we now? Asia-Pac. J. Ophthalmol. 8, 448\u2013456 (2019).","journal-title":"Asia-Pac. J. Ophthalmol."},{"key":"1222_CR3","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/S2213-8587(16)30052-3","volume":"5","author":"G Tan","year":"2017","unstructured":"Tan, G. et al. Diabetic macular oedema. Lancet Diab. Endocrinol. 5, 143\u2013155 (2017).","journal-title":"Lancet Diab. Endocrinol."},{"key":"1222_CR4","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1001\/jamaophthalmol.2016.1669","volume":"134","author":"EL Ross","year":"2016","unstructured":"Ross, E. L. et al. Cost-effectiveness of aflibercept, bevacizumab, and ranibizumab for diabetic macular edema treatment: analysis from the diabetic retinopathy clinical research network comparative effectiveness trial. JAMA Ophthalmol. 134, 888\u2013896 (2016).","journal-title":"JAMA Ophthalmol."},{"key":"1222_CR5","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/j.ophtha.2016.02.022","volume":"123","author":"JA Wells","year":"2016","unstructured":"Wells, J. A. et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology 123, 1351\u20131359 (2016).","journal-title":"Ophthalmology"},{"key":"1222_CR6","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1056\/NEJMoa1414264","volume":"372","author":"JA Wells","year":"2015","unstructured":"Wells, J. A. et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. New Engl. J. Med. 372, 1193\u20131203 (2015).","journal-title":"New Engl. J. Med."},{"key":"1222_CR7","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1016\/j.ophtha.2018.04.007","volume":"125","author":"TY Wong","year":"2018","unstructured":"Wong, T. Y. et al. Guidelines on diabetic eye care: the International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology 125, 1608\u20131622 (2018).","journal-title":"Ophthalmology"},{"key":"1222_CR8","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-13922-8","volume":"11","author":"AV Varadarajan","year":"2020","unstructured":"Varadarajan, A. V. et al. Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning. Nat. Commun. 11, 130 (2020).","journal-title":"Nat. Commun."},{"key":"1222_CR9","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1001\/jamaophthalmol.2015.5332","volume":"134","author":"YT Wang","year":"2016","unstructured":"Wang, Y. T. et al. Comparison of prevalence of diabetic macular edema based on monocular fundus photography vs optical coherence tomography. JAMA Ophthalmol. 134, 222\u2013228 (2016).","journal-title":"JAMA Ophthalmol."},{"key":"1222_CR10","doi-asserted-by":"publisher","first-page":"2959","DOI":"10.2337\/dc17-2612","volume":"43","author":"IYH Wong","year":"2020","unstructured":"Wong, I. Y. H. et al. Incorporating optical coherence tomography macula scans enhances cost-effectiveness of fundus photography-based screening for diabetic macular edema. Diab. Care 43, 2959\u20132966 (2020).","journal-title":"Diab. Care"},{"key":"1222_CR11","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/S2213-8587(19)30411-5","volume":"8","author":"S Vujosevic","year":"2020","unstructured":"Vujosevic, S. et al. Screening for diabetic retinopathy: new perspectives and challenges. Lancet Diab. Endocrinol. 8, 337\u2013347 (2020).","journal-title":"Lancet Diab. Endocrinol."},{"key":"1222_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-022-02458-z","volume":"22","author":"JE Kim","year":"2022","unstructured":"Kim, J. E. et al. Evaluation of a self-imaging SD-OCT system designed for remote home monitoring. BMC Ophthalmol. 22, 261 (2022).","journal-title":"BMC Ophthalmol."},{"key":"1222_CR13","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1038\/s41551-021-00753-6","volume":"5","author":"M Draelos","year":"2021","unstructured":"Draelos, M. et al. Contactless optical coherence tomography of the eyes of freestanding individuals with a robotic scanner. Nat. Biomed. Eng. 5, 726\u2013736 (2021).","journal-title":"Nat. Biomed. Eng."},{"key":"1222_CR14","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1136\/bjo-2023-324012","volume":"108","author":"Z Liu","year":"2024","unstructured":"Liu, Z. et al. Evaluation of a self-imaging OCT for remote diagnosis and monitoring of retinal diseases. Br. J. Ophthalmol. 108, 1154\u20131160 (2024).","journal-title":"Br. J. Ophthalmol."},{"key":"1222_CR15","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1136\/bjophthalmol-2013-304338","volume":"98","author":"G Prescott","year":"2014","unstructured":"Prescott, G. et al. Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study. Br. J. Ophthalmol. 98, 1042\u20131049 (2014).","journal-title":"Br. J. Ophthalmol."},{"key":"1222_CR16","first-page":"1","volume":"1","author":"G Virgili","year":"2015","unstructured":"Virgili, G. et al. Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy. Cochrane Database Syst. Rev. 1, 1\u201358 (2015).","journal-title":"Cochrane Database Syst. Rev."},{"key":"1222_CR17","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.ophtha.2020.06.028","volume":"128","author":"PU Dugel","year":"2021","unstructured":"Dugel, P. U. et al. HAWK and HARRIER: ninety-six-week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology 128, 89\u201399 (2021).","journal-title":"Ophthalmology"},{"key":"1222_CR18","doi-asserted-by":"crossref","unstructured":"Pedersen, E. R. et al. Redesigning clinical pathways for immediate diabetic retinopathy screening results. NEJM Catal. 2, https:\/\/catalyst.nejm.org\/doi\/full\/10.1056\/cat.21.0096 (2021).","DOI":"10.1056\/CAT.21.0096"},{"key":"1222_CR19","doi-asserted-by":"publisher","first-page":"2402","DOI":"10.1001\/jama.2016.17216","volume":"316","author":"V Gulshan","year":"2016","unstructured":"Gulshan, V. et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. J. Am. Med. Assoc. 316, 2402\u20132410 (2016).","journal-title":"J. Am. Med. Assoc."},{"key":"1222_CR20","doi-asserted-by":"crossref","unstructured":"Li, X., Tan, T.-E., Wong, T. & Sun, X. Diabetic retinopathy in China: epidemiology, screening and treatment trends\u2014a review. Clin. Exp. Ophthalmol. 51, 607\u2013626 (2023).","DOI":"10.1111\/ceo.14269"},{"key":"1222_CR21","first-page":"593","volume":"37","author":"Association IMSCoCME.","year":"2019","unstructured":"Association IMSCoCME. Guidelines for artificial intelligent diabetic retinopathy screening system based on fundus photography. Chin. J. Exp. Ophthalmol. 37, 593\u2013598 (2019).","journal-title":"Chin. J. Exp. Ophthalmol."},{"key":"1222_CR22","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1136\/bjophthalmol-2017-310368","volume":"102","author":"G Jin","year":"2018","unstructured":"Jin, G. et al. Prevalence of age-related macular degeneration in rural southern China: the Yangxi Eye Study. Br. J. Ophthalmol. 102, 625\u2013630 (2018).","journal-title":"Br. J. Ophthalmol."},{"key":"1222_CR23","doi-asserted-by":"publisher","first-page":"e682","DOI":"10.1016\/S2468-2667(20)30254-1","volume":"5","author":"T Xu","year":"2020","unstructured":"Xu, T. et al. Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Lancet Public Health 5, e682\u2013e691 (2020).","journal-title":"Lancet Public Health"},{"key":"1222_CR24","doi-asserted-by":"publisher","first-page":"e000766","DOI":"10.1136\/bmjgh-2018-000766","volume":"3","author":"IYH Wong","year":"2018","unstructured":"Wong, I. Y. H. et al. Saving sight in China and beyond: the Lifeline Express model. BMJ Glob. Health 3, e000766 (2018).","journal-title":"BMJ Glob. Health"},{"key":"1222_CR25","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1001\/jama.2017.18152","volume":"318","author":"DSJ Ting","year":"2017","unstructured":"Ting, D. S. J. et al. Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes. J. Am. Med. Assoc. 318, 2211\u20132223 (2017).","journal-title":"J. Am. Med. Assoc."},{"key":"1222_CR26","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1038\/s41746-018-0040-6","volume":"1","author":"MD Abr\u00e0moff","year":"2018","unstructured":"Abr\u00e0moff, M. D. et al. Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices. NPJ Digit. Med. 1, 39 (2018).","journal-title":"NPJ Digit. Med."},{"key":"1222_CR27","doi-asserted-by":"publisher","first-page":"e489","DOI":"10.1016\/S2214-109X(20)30488-5","volume":"9","author":"MJ Burton","year":"2021","unstructured":"Burton, M. J. et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob. Health 9, e489\u2013e551 (2021).","journal-title":"Lancet Glob. Health"},{"key":"1222_CR28","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ajo.2018.07.006","volume":"194","author":"T Chen","year":"2018","unstructured":"Chen, T. et al. A mobile phone informational reminder to improve eye care adherence among diabetic patients in rural China: a randomized controlled trial. Am. J. Ophthalmol. 194, 54\u201362 (2018).","journal-title":"Am. J. Ophthalmol."},{"key":"1222_CR29","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.media.2019.02.011","volume":"54","author":"D Lu","year":"2019","unstructured":"Lu, D. et al. Deep-learning based multiclass retinal fluid segmentation and detection in optical coherence tomography images using a fully convolutional neural network. Med. Image Anal. 54, 100\u2013110 (2019).","journal-title":"Med. Image Anal."},{"key":"1222_CR30","doi-asserted-by":"publisher","first-page":"e172","DOI":"10.1016\/S2589-7500(19)30085-8","volume":"1","author":"AR Ran","year":"2019","unstructured":"Ran, A. R. et al. Detection of glaucomatous optic neuropathy with spectral-domain optical coherence tomography: a retrospective training and validation deep-learning analysis. Lancet Digit. Health 1, e172\u2013e182 (2019).","journal-title":"Lancet Digit. Health"},{"key":"1222_CR31","doi-asserted-by":"publisher","first-page":"101052","DOI":"10.1016\/j.preteyeres.2022.101052","volume":"90","author":"DC Hood","year":"2022","unstructured":"Hood, D. C. et al. Detecting glaucoma with only OCT: Implications for the clinic, research, screening, and AI development. Prog. Retin. Eye Res. 90, 101052\u2013101052 (2022).","journal-title":"Prog. Retin. Eye Res."},{"key":"1222_CR32","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1001\/jamaneurol.2018.1578","volume":"75","author":"F Ko","year":"2018","unstructured":"Ko, F. et al. Association of retinal nerve fiber layer thinning with current and future cognitive decline: a study using optical coherence tomography. JAMA Neurol. 75, 1198\u20131205 (2018).","journal-title":"JAMA Neurol."},{"key":"1222_CR33","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(22)00554-x","author":"H Liu","year":"2023","unstructured":"Liu, H. et al. Economic evaluation of combined population-based screening for multiple blindness-causing eye diseases in China: a cost-effectiveness analysis. Lancet Glob. Health https:\/\/doi.org\/10.1016\/s2214-109x(22)00554-x (2023).","journal-title":"Lancet Glob. Health"},{"key":"1222_CR34","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06555-x","author":"Y Zhou","year":"2023","unstructured":"Zhou, Y. et al. A foundation model for generalizable disease detection from retinal images. Nature https:\/\/doi.org\/10.1038\/s41586-023-06555-x (2023).","journal-title":"Nature"},{"key":"1222_CR35","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1001\/jamaophthalmol.2020.5981","volume":"139","author":"Y Liu","year":"2021","unstructured":"Liu, Y., Liu, Y., Zheng, Y., Zheng, Y. & Bressler, N. M. Express medicine-potential for home-based medical care. JAMA Ophthalmol. 139, 269\u2013270 (2021).","journal-title":"JAMA Ophthalmol."},{"key":"1222_CR36","unstructured":"National Health Service Diabetic Eye Screening: Programme: grading definitions for referable disease, 2021. https:\/\/www.gov.uk\/government\/publications\/diabetic-eye-screening-retinal-image-grading-criteria\/nhs-diabetic-eye-screening-programme-grading-definitions-for-referable-disease#grading-classification-for-maculopathy--groups-of-exudates-m1 (2024)."},{"key":"1222_CR37","doi-asserted-by":"publisher","first-page":"3432","DOI":"10.1167\/iovs.08-2970","volume":"50","author":"UE Wolf-Schnurrbusch","year":"2009","unstructured":"Wolf-Schnurrbusch, U. E. et al. Macular thickness measurements in healthy eyes using six different optical coherence tomography instruments. Invest. Ophthalmol. Vis. Sci. 50, 3432\u20133437 (2009).","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"1222_CR38","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1001\/jamaophthalmol.2014.1698","volume":"132","author":"SB Bressler","year":"2014","unstructured":"Bressler, S. B. et al. Reproducibility of spectral-domain optical coherence tomography retinal thickness measurements and conversion to equivalent time-domain metrics in diabetic macular edema. JAMA Ophthalmol. 132, 1113\u20131122 (2014).","journal-title":"JAMA Ophthalmol."},{"key":"1222_CR39","first-page":"18","volume":"38","author":"W Zhang","year":"2016","unstructured":"Zhang, W. & Wei, M. The evaluation of the mortality and life expectancy of Chinese population. Popul. J. 38, 18\u201328 (2016).","journal-title":"Popul. J."},{"key":"1222_CR40","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/S0008-4182(00)80077-0","volume":"35","author":"S Sharma","year":"2000","unstructured":"Sharma, S. et al. Converting visual acuity to utilities. Can. J. Ophthalmol. 35, 267\u2013272 (2000).","journal-title":"Can. J. Ophthalmol."},{"key":"1222_CR41","first-page":"100435","volume":"23","author":"R Li","year":"2022","unstructured":"Li, R. et al. Cost-effectiveness and cost-utility of traditional and telemedicine combined population-based age-related macular degeneration and diabetic retinopathy screening in rural and urban China. Lancet Reg. Health West. Pac. 23, 100435\u2013100435 (2022).","journal-title":"Lancet Reg. Health West. Pac."},{"key":"1222_CR42","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.ophtha.2012.09.002","volume":"120","author":"S Rachapelle","year":"2013","unstructured":"Rachapelle, S. et al. The cost\u2013utility of telemedicine to screen for diabetic retinopathy in India. Ophthalmology 120, 566\u2013573 (2013).","journal-title":"Ophthalmology"},{"key":"1222_CR43","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2020-318690","author":"K Liu","year":"2021","unstructured":"Liu, K. et al. Intravitreal conbercept for diabetic macular oedema: 2-year results from a randomised controlled trial and open-label extension study. Br. J. Ophthalmol. https:\/\/doi.org\/10.1136\/bjophthalmol-2020-318690 (2021).","journal-title":"Br. J. Ophthalmol."},{"key":"1222_CR44","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1478-7547-1-8","volume":"1","author":"R Hutubessy","year":"2003","unstructured":"Hutubessy, R., Chisholm, D. & Edejer, T. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost. Eff. Resour. Alloc. 1, 8 (2003).","journal-title":"Cost. Eff. Resour. Alloc."},{"key":"1222_CR45","doi-asserted-by":"publisher","first-page":"479","DOI":"10.2165\/00019053-200017050-00006","volume":"17","author":"A Briggs","year":"2000","unstructured":"Briggs, A. Handling uncertainty in cost-effectiveness models. PharmacoEconomics 17, 479\u2013500 (2000).","journal-title":"PharmacoEconomics"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01222-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01222-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01222-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T14:09:54Z","timestamp":1724508594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01222-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,24]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1222"],"URL":"https:\/\/doi.org\/10.1038\/s41746-024-01222-5","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,24]]},"assertion":[{"value":"15 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors, except Y.F. Zheng and P. Li, declare no competing financial or non-financial interests. P. Li is the employee of MOPTIM Imaging Technique Co., Ltd (Shenzhen, China), which developed and produced the self-imaging OCT device used in this study. Y.F. Zheng and P. Li have patents on the self-imaging OCT device and the automated imaging analysis system associated with the imaging software used in this study. None of the foundations hereby is associated directly or indirectly with the participant or design of this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"225"}}