{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:58:53Z","timestamp":1789570733552,"version":"build-2803163510"},"reference-count":35,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">\n                        Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (P\n                        <jats:sub>pos<\/jats:sub>\n                        ) or negative agreement (P\n                        <jats:sub>neg<\/jats:sub>\n                        ) were used to assess variability.\n                      <\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">\n                        Among cases deemed gradable by all three readers (n\u2009=\u200965), there was substantial agreement on absence of any retinopathy (88%\u2009\u00b1\u20094.6%, P\n                        <jats:sub>neg<\/jats:sub>\n                        \u2009=\u20090.91\u20130.95), presence of moderate nonproliferative or worse retinopathy (87%\u2009\u00b1\u20093.9%, P\n                        <jats:sub>pos<\/jats:sub>\n                        \u2009=\u20090.67\u20131.00), and presence of macular edema (99%\u2009\u00b1\u20090.9%, P\n                        <jats:sub>pos<\/jats:sub>\n                        \u2009=\u20090.67\u20131.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61%\u2009\u00b1\u200911%, P\n                        <jats:sub>pos<\/jats:sub>\n                        \u2009=\u20090.21\u20130.59) and early, nonroutine referral for a follow-up clinical eye exam (66%\u2009\u00b1\u20098.1%, P\n                        <jats:sub>pos<\/jats:sub>\n                        \u2009=\u20090.19\u20130.54). Among all cases (n\u2009=\u2009100), there was acceptable agreement regarding which had gradable images (77%\u2009\u00b1\u20095.0%, P\n                        <jats:sub>pos<\/jats:sub>\n                        \u2009=\u20090.50\u20130.90).\n                      <\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/tmj.2018.0019","type":"journal-article","created":{"date-parts":[[2018,7,24]],"date-time":"2018-07-24T14:56:46Z","timestamp":1532444206000},"page":"301-308","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program"],"prefix":"10.1177","volume":"25","author":[{"given":"Yao","family":"Liu","sequence":"first","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria P.","family":"Rajamanickam","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi S.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Yale School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J.","family":"Loomis","sequence":"additional","affiliation":[{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn E.","family":"Kloek","sequence":"additional","affiliation":[{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo A.","family":"Kim","sequence":"additional","affiliation":[{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy L.","family":"Hitchmoth","sequence":"additional","affiliation":[{"name":"White River Junction Veteran's Affairs Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Song","sequence":"additional","affiliation":[{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean C.","family":"Xerras","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Chelsea HealthCare Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis R.","family":"Pasquale","sequence":"additional","affiliation":[{"name":"Harvard Medical School"},{"name":"Brigham and Women's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,4,10]]},"reference":[{"key":"e_1_3_5_2_2","volume-title":"Estimates of diabetes and its burden in the United States, 2014","author":"National Diabetes Statistics Report","year":"2014","unstructured":"National Diabetes Statistics Report. Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014."},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(03)00817-0"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.2337\/diaclin.27.4.140"},{"key":"e_1_3_5_5_2","first-page":"2","volume-title":"Eye care of the patients with diabetes mellitus","author":"American Optometric Association.","year":"2014","unstructured":"American Optometric Association.. Evidence-based clinical practice guideline. In: Evidence-based Optometry Guideline Development Group. Eye care of the patients with diabetes mellitus. St. Louis, MO: American Optometric Association, 2014:2\u201383."},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.SLA.0000081085.98792.3d"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-8-29"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2005.12.025"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-0295"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2015.1"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-017-0974-1"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.06.029"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1601705"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2010.0466"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2009.11.014"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2005.11.021"},{"key":"e_1_3_5_17_2","first-page":"715","article-title":"Accuracy of diabetic retinopathy screening by trained nonphysician graders using nonmydriatic fundus camera","volume":"53","author":"Bhargava M","year":"2012","unstructured":"Bhargava M, , Cheung CY, , Sabanayagam C, et al. Accuracy of diabetic retinopathy screening by trained nonphysician graders using nonmydriatic fundus camera. Singapore Med J, 2012; 53:715\u2013719.","journal-title":"Singapore Med J"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006982-200304000-00013"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2011.0075"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.09-4886"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(90)90158-L"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(90)90159-M"},{"key":"e_1_3_5_23_2","first-page":"1","article-title":"A comparison of consensus, consistency, and measurement approaches to estimating interrater reliability","volume":"9","author":"Stemler SE","year":"2004","unstructured":"Stemler SE. A comparison of consensus, consistency, and measurement approaches to estimating interrater reliability. Pract Assess Res Eval, 2004; 9:1\u201311.","journal-title":"Pract Assess Res Eval"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1901\/jaba.1977.10-103"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2009.02.031"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/eye.1996.18"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2004.10.064"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-306536"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2014.4652"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2013.1743"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17216"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17563"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.04.018"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2004.03.002"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2010.193"}],"container-title":["Telemedicine and e-Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/tmj.2018.0019","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/tmj.2018.0019","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/tmj.2018.0019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:26:39Z","timestamp":1777587999000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/tmj.2018.0019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1089\/tmj.2018.0019"],"URL":"https:\/\/doi.org\/10.1089\/tmj.2018.0019","relation":{},"ISSN":["1530-5627","1556-3669"],"issn-type":[{"value":"1530-5627","type":"print"},{"value":"1556-3669","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}