Computer Aided Detection of Diabetic Retinopathy in Veterans with Diabetes

描述(由申请人提供)： 这是一项精心开发的研究提案的重新提交，该提案将人类对糖尿病视网膜病变的评估与计算机辅助评估进行比较，这引起了许多兴趣和讨论。申请人对先前的批评作出了很好的答复。这一建议有可能立即提高医疗保健系统的效率，降低总体成本，同时不会对患者本身产生不良影响。人们仍然担心这项研究是否会或如何改进算法，以及关于知识产权的问题。 公共卫生相关性： 退伍军人糖尿病视网膜病变的计算机辅助检测糖尿病视网膜病变是一种令人畏惧的糖尿病并发症，也是导致退伍军人失明的重要原因。退伍军人管理局通过护理协调办公室，一直在迅速转向为所有患有糖尿病的退伍军人进行照片筛选，使用数码相机和有执照的独立从业者作为阅读器。专家阅读存在观察者内部和观察者之间的变异性，专家读者稀缺，成本高，更替率高。申请人开发的对DR的计算机检测具有增加光筛选计划的成本效益、可扩展性、再现性和可持续性的潜力。然而，怀疑论者仍在科学界，计算机对DR的检测尚未在临床实践中得到证实。申请者将比较人类专家、计算机辅助人类专家和独立计算机在敏感性、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.