Diabetic retinopathy screening using a virtual reading center

To summarize the effects of centralization of diabetic fundus photograph interpretation into a virtual reading center. In 2016 Kaiser Permanente Northern California, a large, membership-based health plan with an ethnically and racially diverse population, centralized diabetic retinopathy screening into a virtual reading center. Retina screens were based on single field, 45-degree fundus photographs. We compared the accuracy of photography interpretation the year before centralization to the year after using masked reads performed by retina specialists of 1000 randomly selected screens from each time period. In all, 1902 patient screens with adequate quality images were included in the primary analysis. Images from pre-centralization screens were largely read by ophthalmologists (76.2%), while screens post-centralization were mainly read by optometrists (84.6%). Despite being interpreted by readers with lower levels of professional training, the sensitivity of screening increased from 43.9% (95% CI 38.0–49.8%) to 66.0% (95% CI 60.5–71.4%). A move to a centralized virtual reading center was associated with improved accuracy of diabetic retinopathy screening.