Computer Aided Detection of Diabetic Retinopathy in Veterans with Diabetes

描述（由申请人提供）： 这是一个完善的研究计划的重新提交，以比较糖尿病视网膜病变的人类评估与计算机辅助评估，产生了很多兴趣和讨论。 申请人对之前的批评做出了很好的回应。这项建议有可能即时提高医护系统的效率，并减低整体成本，同时对病人本身并无不良影响。 人们仍然担心这项研究是否会或如何改进算法，以及知识产权问题。 公共卫生相关性： 糖尿病视网膜病变（DR）是糖尿病的一种可怕的并发症，也是退伍军人失明的重要原因。退伍军人事务部通过护理协调办公室，使用数码相机和有执照的独立从业人员作为读者，迅速为所有患有糖尿病的退伍军人进行照片筛查。专家阅读存在观察者内和观察者间的差异，专家阅读器稀缺、昂贵且流失率高。由申请人开发的DR的计算机检测具有增加光筛选程序的成本效益、可扩展性、再现性和可持续性的潜力。然而，怀疑论者仍然存在于科学界，DR的计算机检测在临床实践中未经证实。 申请人将比较人类专家、计算机辅助人类专家和独立计算机在灵敏度、特异性、诊断时间方面的表现，并对大量退伍军人进行DR检测的成本效益分析。

DESCRIPTION (provided by applicant): This is a resubmission of a well-developed research proposal to compare human assessment of diabetic retinopathy to that of computer assisted assessment that generated a lot of interest and discussion. The applicant provided a good response to the previous critiques. This proposal has the potential to result in immediate benefits to efficiency of the health care system and reduce overall costs, while having no undesirable effect on patients themselves. There remain concerns about if or how the algorithm will be improved as a result of this study, and questions about intellectual property. PUBLIC HEALTH RELEVANCE: Computer Aided Detection of Diabetic Retinopathy (DR) in Veterans with Diabetes DR is a feared complication of diabetes and an important cause of blindness in veterans. The VA, through the Office of Care Coordination, has been rapidly moving to photoscreening for all veterans with diabetes, using digital cameras and licensed independent practitioners as readers. Expert reading suffers from intra-and inter-observer variability, and expert readers are scarce, costly and have high turnover rate. Computer detection of DR as developed by the applicant has the potential to increase the cost-effectiveness, scalability, reproducibility and sustainability of photoscreening programs. However, skeptics remain within the scientific community and computer detection of DR is unproven in clinical practice. The applicant will compare the performance of human experts, human experts aided by computer, and standalone computer on sensitivity, specificity, time to diagnosis, and also perform a cost-effectiveness analysis of DR detection on a large number of veterans.