Harnessing the medical undergraduate human resource for screening of sight-threatening diabetic retinopathy

Purpose:To assess whether medical undergraduates can be trained to effectively screen diabetic retinopathy (DR) by statistical comparison with a retina specialist at a tertiary eye care center in India.Methods:Three final-year undergraduate medical students, having completed ophthalmology department rotation, received training from a retina specialist for grading DR, following which they were asked to grade a set of 50 fundus photographs centered on the macula with a view of 50 degrees as sight-threatening DR (STDR), diabetic macular edema, and grade of DR. Agreement among the undergraduates and retina specialist was determined with the help of Cohen's Kappa coefficient.Results:Kappa coefficient between undergraduates for detection of STDR ranged from 0.695 to 0.817 and between each student and the retina specialist ranged from 0.663 to 0.712. The sensitivity and specificity for undergraduates' and retina specialist's detection of STDR were 93.93%-96.96% and 60%, respectively.Conclusion:There was substantial agreement among the undergraduates as well as between the undergraduates and the retina specialist for the detection of STDR. Undergraduates also detected STDR with a high sensitivity. This study outlines the feasibility of training undergraduate students for screening DR.