{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:29:21Z","timestamp":1792294161429,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T00:00:00Z","timestamp":1607990400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Rajavithi Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2020,12,15]]},"abstract":"<jats:p>Objective. To evaluate diabetic retinopathy (DR) screening via deep learning (DL) and trained human graders (HG) in a longitudinal cohort, as case spectrum shifts based on treatment referral and new-onset DR. Methods. We randomly selected patients with diabetes screened twice, two years apart within a nationwide screening program. The reference standard was established via adjudication by retina specialists. Each patient\u2019s color fundus photographs were graded, and a patient was considered as having sight-threatening DR (STDR) if the worse eye had severe nonproliferative DR, proliferative DR, or diabetic macular edema. We compared DR screening via two modalities: DL and HG. For each modality, we simulated treatment referral by excluding patients with detected STDR from the second screening using that modality. Results. There were 5,738 patients (12.3% STDR) in the first screening. DL and HG captured different numbers of STDR cases, and after simulated referral and excluding ungradable cases, 4,148 and 4,263 patients remained in the second screening, respectively. The STDR prevalence at the second screening was 5.1% and 6.8% for DL- and HG-based screening, respectively. Along with the prevalence decrease, the sensitivity for both modalities decreased from the first to the second screening (DL: from 95% to 90%, <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>=<\/a:mo>\n                        <a:mn>0.008<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>; HG: from 74% to 57%, <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>&lt;<\/c:mo>\n                        <c:mn>0.001<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>). At both the first and second screenings, the rate of false negatives for the DL was a fifth that of HG (0.5-0.6% vs. 2.9-3.2%). Conclusion. On 2-year longitudinal follow-up of a DR screening cohort, STDR prevalence decreased for both DL- and HG-based screening. Follow-up screenings in longitudinal DR screening can be more difficult and induce lower sensitivity for both DL and HG, though the false negative rate was substantially lower for DL. Our data may be useful for health-economics analyses of longitudinal screening settings.<\/jats:p>","DOI":"10.1155\/2020\/8839376","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T19:23:33Z","timestamp":1608146613000},"page":"1-8","source":"Crossref","is-referenced-by-count":17,"title":["Longitudinal Screening for Diabetic Retinopathy in a Nationwide Screening Program: Comparing Deep Learning and Human Graders"],"prefix":"10.1155","volume":"2020","author":[{"given":"Jirawut","family":"Limwattanayingyong","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Variya","family":"Nganthavee","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasem","family":"Seresirikachorn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tassapol","family":"Singalavanija","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngamphol","family":"Soonthornworasiri","sequence":"additional","affiliation":[{"name":"Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varis","family":"Ruamviboonsuk","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of 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Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Schaekermann","sequence":"additional","affiliation":[{"name":"Google Health, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily H.","family":"Peng","sequence":"additional","affiliation":[{"name":"Google Health, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale R.","family":"Webster","sequence":"additional","affiliation":[{"name":"Google Health, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Semturs","sequence":"additional","affiliation":[{"name":"Google Health, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Krause","sequence":"additional","affiliation":[{"name":"Google Health, Palo Alto, CA, 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-6220","authenticated-orcid":true,"given":"Paisan","family":"Ruamviboonsuk","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.03.024"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30411-5"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-017-0974-1"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1111\/j.0954-6820.1982.tb03213.x"},{"key":"5","unstructured":"Diabetic RetinaScreenThe National Diabetic Retinal Screening ProgrammeIreland2020, 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