E-Mail karger@karger.com Original Paper Ophthalmologica 2015;233:96–103 DOI: 10.1159/000368426 Screening for Diabetic Retinopathy in the Central Region of Portugal. Added Value of Automated ‘Disease/No Disease’ Grading Luisa Ribeiro   a Carlos Manta Oliveira   b Catarina Neves   a João Diogo Ramos   b Hélder Ferreira   c José Cunha-Vaz   a, d a  AIBILI, CORC – Association for Innovation and Biomedial Research on Light and Image, Coimbra Ophthalmology Reading Center, b  Retmarker SA, c  Regional Health Administration of the Central Region of Portugal, and d  Faculty of Medicine of University of Coimbra, Coimbra, Portugal Introduction At 20 years after diagnosis, more than 90% of patients with type I diabetes and more than 60% of those with type 2 diabetes will have some degree of diabetic retinopathy (DR) [1, 2]. DR is a common and serious condition. It is the leading cause of blindness among working-age adults in the USA [3]. Vision loss related to eye disease among people with diabetes is an important disability that threat- ens independence and can lead to depression, reduced mobility and reduced quality of life [4]. With early detec- tion, DR can be treated with modalities that have been proven to decrease the risk of severe vision loss by more than 90% [5] and because of these benefits some profes- sional organizations such as the American Diabetes As- sociation and the American Academy of Ophthalmology have established guidelines for DR screening. However, less than 50% of diabetic patients in the USA meet these recommendations [6–8]. DR meets the criteria for screening, allowing early de- tection of DR lesions and timely referral for treatment. It is detectable in a presymptomatic stage, and the develop- ment of vision loss can be prevented if treatment is given timely to treat sight-threatening complications such as diabetic macular edema and proliferative DR. Further- more, screening for DR has been shown to be cost-effec- Key Words Diabetic retinopathy · Screening · Automated grading · Fundus photography Abstract Purpose: To describe the procedures of a nonmydriatic dia- betic retinopathy (DR) screening program in the Central Re- gion of Portugal and the added value of the introduction of an automated disease/no disease analysis. Methods: The images from the DR screening program are analyzed in a central reading center using first an automated disease/no disease analysis followed by human grading of the disease cases. The grading scale used is as follows: R0 – no retinop- athy, RL – nonproliferative DR, M – maculopathy, RP – pro- liferative DR and NC – not classifiable. Results: Since the introduction of automated analysis in July 2011, a total of 89,626 eyes (45,148 patients) were screened with the follow- ing distribution: R0 – 71.5%, RL – 22.7%, M – 2.2%, RP – 0.1% and NC – 3.5%. The implemented automated system showed the potential for human grading burden reduction of 48.42%. Conclusions: Screening for DR using automated analysis allied to a simplified grading scale identifies DR vi- sion-threatening complications well while decreasing hu- man burden. © 2014 S. Karger AG, Basel Received: September 2, 2014 Accepted: September 5, 2014 Published online: November 26, 2014 Ophthalmologica Luisa Ribeiro AIBILI, Azinhaga de Santa Comba, Celas PT–3000-548 Coimbra (Portugal) E-Mail lr  @  aibili.pt © 2014 S. Karger AG, Basel 0030–3755/14/2332–0096$39.50/0 www.karger.com/oph