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Detection and Classification of Diabetic Retinopathy From Posterior Pole Images With A Deep Learning Model

Detection and Classification of Diabetic Retinopathy From Posterior Pole Images With A Deep Learning Model

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT04805541
Enrollment
900
Registered
2021-03-18
Start date
2022-02-01
Completion date
2022-07-04
Last updated
2024-07-15

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Diabetic Retinopathy, Diabetic Eye Problems, Diabetic Macular Edema

Brief summary

The duration of diabetes is directly related to eye complications. Diabetic retinopathy affects 80 percent of those who have had diabetes for 20 years or more. At least 90% of new cases can be reduced with proper treatment and monitoring of the eyes. The longer a person has diabetes, the more likely it is to develop diabetic retinopathy. Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness in people between the ages of 20 and 64. The most important complication of diabetes leading to vision loss is diabetic retinopathy. Depending on this, macular edema, bleeding into the retina and vitreous,neovascular glaucoma can cause blindness. Diabetic retinopathy (DR) is a leading cause of vision-loss globally. Of an estimated 285 million people with diabetes mellitus worldwide, approximately one third have signs of DR and of these, a further one third of DR is vision-threatening DR, including diabetic macular edema (DME). Diabetic retinopathy is a retinal disease that can often be stopped with early diagnosis, but if neglected, it can lead to severe vision loss, including permanent blindness. Diabetes has high morbidity and there are millions of people who should be screened for diabetic retinopathy (DR). Annual eye screening is recommended for all diabetic patients since vision loss can be prevented if DR is diagnosed in its early stages. Currently, the number of clinical personnel trained for DR screening is less than that needed to screen a growing diabetic population. Therefore, the automatic DR screening system will be able to screen more diabetic patients and diagnose them early. EyeCheckup is an automated retinal screening device designed automatically analyze color fundus photographs of diabetic patients to identify patients with referable or vision threatening DR. This study is designed to assess the safety and efficacy of EyeCheckup. The study is a single center study to determine the sensitivity and specificity of EyeCheckup to diabetic retinopathy. EyeCheckup is an automated software device that is designed to analyze ocular fundus digital color photographs taken in frontline primary care settings in order to quickly screen for diabetic retinopathy (DR).

Detailed description

This is a prospective study to assess the safety and efficacy of EyeCheckup in screening for DR. This study was carried out in a single center at Akdeniz University Faculty of Medicine with primary endpoints to determine the sensitivity and specificity of EyeCheckup to diabetic retinopathy in the primary care setting. Methods and tools to be used in the study: * Fundus photography with non-mydriatic camera and classification of diabetic retinopathy with artificial intelligence algorithm, * Evaluation of seven field dilated fundus images by retina specialists and comparison of results for clinical validation of the system. Clinical and laboratory tests to be performed: * Fundus photography with a non-mydriatic camera. In this study, no invasive procedure is applied to the patient, the retinal photograph will be taken with a special digital camera called a fundus camera. In patients whose non-mydriatic image cannot be obtained, tropicamide drops will be instilled to dilate the pupil, and then photographs will be taken. * Pupil dilation will be achieved by instilling Tropicamide drops in both eyes of the patient, and then 4 quadrant photographs of both eyes will be taken with a mydriatic fundus camera. After exclusions, this study will enroll up to 900 subjects who are diagnosed with diabetes by the endocrinology polyclinic and meet the eligibility criteria. Participants who meet the eligibility criteria will be recruited after obtaining written informed consent from primary health care providers. Subjects will undergo fundus photography per, Food and Drug Administration (FDA) cleared, ophthalmic cameras (product code: HKI). Images will be taken according to a specific EyeCheckup imaging protocol provided to the ophthalmic camera operator and then analyzed by the EyeCheckup device. The photography protocol consists of two images of the ocular fundus (one optic disc nerve centered, one macula centered), obtained from both eyes of enrolled participants. After the retinal images taken from ophthalmic cameras (product code: HKI), images are analyzed with EyeCheckup and a scan report is prepared. If it is necessary to enlarge the pupils, eye enlarging eye drops are applied and wait 15-30 minutes. This information is noted. DR is diagnosed by examination by a retina specialist with the captured images. EyeCheckup success rate is calculated by comparing both reports.

Interventions

Subjects will undergo fundus photography before and after administration of mydriatic agent.

Subjects will be administered mydriatic medication to dilate their pupils.

DEVICEEyeCheckup - AI Based DR Screening

Screening for existence of More than mild or Vision-threatening Diabetic Retinopathy, and/or Diabetic Macular Edema.

Sponsors

Akdeniz University
CollaboratorOTHER
Ural Telekomunikasyon Sanayi Ticaret Anonim Sirketi
Lead SponsorINDUSTRY

Study design

Observational model
CASE_ONLY
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* A diagnosis of diabetes mellitus * Understanding of study and provision of written informed consent * 18 years of age or older * No history of any other retinal vascular disease, glaucoma, or other disease that may affect the appearance of the retina or optic disc (refractive error and ocular surface disease are allowed) * Other than cataract surgery, no history of intraocular surgery, ocular laser treatments for any retinal disease, or ocular injections for diabetic macular edema or proliferative disease No media opacity precluding good retinal photography

Exclusion criteria

* No diagnosis of diabetes mellitus * Potential subject cannot understand study or informed consent * A history of retinal vascular disease other than diabetic retinopathy that may affect the appearance of the retina or optic disc * Previous intraocular surgery including cataract; previous laser to the retina; or previous intraocular injections for the treatment of diabetic retinopathy * Pregnant women or women with gestational diabetes mellitus * A media opacity in either eye that is severe enough to preclude good retinal photography * Permanent vision impairment in one or both eyes * The participant is contraindicated for imaging with fundus imaging systems used in the study: * Participant is hypersensitive to light * Participant recently received photodynamic therapy (PDT) * Participant uses drugs that cause photosensitivity

Design outcomes

Primary

MeasureTime frameDescription
Sensitivity(mtmDR)1 visit (1 day)Sensitivity for detecting more than mild diabetic retinopathy
Sensitivity(vtDR)1 visit (1 day)Sensitivity for detecting vision threatening diabetic retinopathy
Specificity(mtmDR)1 visit (1 day)Specificity for detecting more than mild diabetic retinopathy
Specificity(vtDR)1 visit (1 day)Specificity for detecting vision threatening diabetic retinopathy

Secondary

MeasureTime frameDescription
Diagnosability1 Daypercentage of patients with image quality sufficient for EyeCheckup to produce an output to patients with image quality sufficient for the clinical reference standard to produce an output
Non-Dilated EyeCheckup Usage1 DayPercentage of participants for whom Non-Dilated Images were sufficient to use EyeCheckup

Countries

Turkey (Türkiye)

Participant flow

Recruitment details

Participants were reffered to by the Endocrionlogy Department at Akdeniz University Hosptital for an ophthalmic examitation to the opthalmology department to screen for diabetic retinopathy, where they were invited to participate in the study.

Pre-assignment details

Participants were evaluated for media opacity and other retinal diseases that might prevent good retinal photography.

Participants by arm

ArmCount
Screening Population
Prospective Study Participants
900
Total900

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyUnable to be retinally photographed with good quality.35

Baseline characteristics

CharacteristicScreening Population
Age, Continuous58.33 years
STANDARD_DEVIATION 11.16
Race and Ethnicity Not Collected— Participants
Region of Enrollment
Turkey
900 participants
Sex: Female, Male
Sex
Female
442 Participants
Sex: Female, Male
Sex
Male
458 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 865
other
Total, other adverse events
0 / 865
serious
Total, serious adverse events
0 / 865

Outcome results

Primary

Sensitivity(mtmDR)

Sensitivity for detecting more than mild diabetic retinopathy

Time frame: 1 visit (1 day)

ArmMeasureValue (NUMBER)
Prospective Study Participants (Optomed)Sensitivity(mtmDR)90.48 percentage of true positives
Prospective Study Participants (Canon)Sensitivity(mtmDR)95.65 percentage of true positives
Prospective Study Participants (Topcon)Sensitivity(mtmDR)95.19 percentage of true positives
Primary

Sensitivity(vtDR)

Sensitivity for detecting vision threatening diabetic retinopathy

Time frame: 1 visit (1 day)

ArmMeasureValue (NUMBER)
Prospective Study Participants (Optomed)Sensitivity(vtDR)95.12 percentage of true positives
Prospective Study Participants (Canon)Sensitivity(vtDR)96.00 percentage of true positives
Prospective Study Participants (Topcon)Sensitivity(vtDR)96.34 percentage of true positives
Primary

Specificity(mtmDR)

Specificity for detecting more than mild diabetic retinopathy

Time frame: 1 visit (1 day)

ArmMeasureValue (NUMBER)
Prospective Study Participants (Optomed)Specificity(mtmDR)97.21 percentage of true negatives
Prospective Study Participants (Canon)Specificity(mtmDR)95.92 percentage of true negatives
Prospective Study Participants (Topcon)Specificity(mtmDR)95.93 percentage of true negatives
Primary

Specificity(vtDR)

Specificity for detecting vision threatening diabetic retinopathy

Time frame: 1 visit (1 day)

ArmMeasureValue (NUMBER)
Prospective Study Participants (Optomed)Specificity(vtDR)98.82 percentage of true negatives
Prospective Study Participants (Canon)Specificity(vtDR)96.34 percentage of true negatives
Prospective Study Participants (Topcon)Specificity(vtDR)95.93 percentage of true negatives
Secondary

Diagnosability

percentage of patients with image quality sufficient for EyeCheckup to produce an output to patients with image quality sufficient for the clinical reference standard to produce an output

Time frame: 1 Day

ArmMeasureValue (NUMBER)
Prospective Study Participants (Optomed)Diagnosability96.57 percentage of participants
Prospective Study Participants (Canon)Diagnosability100 percentage of participants
Prospective Study Participants (Topcon)Diagnosability100 percentage of participants
Secondary

Non-Dilated EyeCheckup Usage

Percentage of participants for whom Non-Dilated Images were sufficient to use EyeCheckup

Time frame: 1 Day

ArmMeasureValue (NUMBER)
Prospective Study Participants (Optomed)Non-Dilated EyeCheckup Usage62.24 percentage of patients imaged undilated
Prospective Study Participants (Canon)Non-Dilated EyeCheckup Usage68.90 percentage of patients imaged undilated
Prospective Study Participants (Topcon)Non-Dilated EyeCheckup Usage78.46 percentage of patients imaged undilated

Source: ClinicalTrials.gov · Data processed: Feb 6, 2026