Comparison of Digital Retinal Images and Information Tele-Transferred Through the Hala System to Manual Image Transfer of Diabetic Patients from Primary Health Care Centers in Riyadh

Background: Diabetes is a significant problem in Saudi Arabia, and telemedicine in the form of tele-screening for diabetic retinopathy (DR) is recommended. Introduction: A comparison of the quality of images and information transferred through the Hala system of the Ministry of Health, Saudi Arabia, with images transferred in a survey at Primary Healthcare Centers in Riyadh, Saudi Arabia, was conducted. Methods: A review of health records was undertaken in 2017-2018. Digital retinal images of diabetics were tele-transferred from a diabetes center to the King Khaled Eye Specialist Hospital (KKESH) for review by medical retina specialists (Group I). Similarly, images of diabetic patients that were transferred from seven primary health clinics to KKESH during a survey were used as images for research (Group II). Additional information reviewed for completeness included patient demographics, risk factors of DR, and previous eye surgery. Results: There were 40 images of 40 patients transferred through the Hala system. There were 120 randomly selected images from survey files. There were significantly more poor images from the Hala system (12.5%) than the research survey system (2.4%). There was no significant difference in the severity of DR between groups. The median Rasch score for the images was -0.58 (interquartile range [IQR] -5.6, 2.6) in Group I and 19.7 (IQR 18.3, 19.7) in Group II. The image reader perceived that the quality of digital retinal images was significantly better in images transferred from the research survey compared with those transferred through the Hala DR tele-transfer system. (Mann-Whitney p < 0.001). Conclusions: Digital image capture and supplementary risk factor information require improvement to enhance DR screening using the Hala system.