There are two different approaches for DR photograph reading in clinical practice, i.e., photograph reading by clinical physicians (physician reading) and photograph reading by a third-party reading center (third-party reading). No matter which approach is selected, it is essentially important that the DR reading procedures be implemented in the routine clinical practice in a sustainable way for the clinical institute.

Physician Reading

It is encouraged that physicians do the general DR photograph reading by his/her self for their own patients, with the systemic quality control supports from a third-party photograph center.[4]

The following reading procedures could be well performed by clinical physicians without difficulty:

  1. DR screening reading, if the physician feels challenges with general diagnostic reading procedure. Third-party support for diagnostic reading is required for this type of procedure.
  2. DR general diagnostic reading: most general physicians will not feel difficulty with this procedure when the JCPI module for DR (integrated with MedLink platform) is used. Therefore, it is recommended that clinical physicians do the General DR evaluation (level II reading) for their own patients in their daily clinical practice.
  3. Ophthalmic DR reading with simplified procedure, such as International Classification of Diabetic Retinopathy: this is for eye care specialists. When the JCPI module for DR (integrated with MedLink platform) is used, systemic quality control supports will be possible for the eye physicians for Ophthalmic simplified DR reading procedure.

The advantage of the physician reading is the efficiency. There is no need for the physicians to wait for the reading reports from third-party reading centers.

Physicians be reminded that they can always seek services from a contracted third-party reading center for General Diagnostic Reading, Ophthalmic Simplified DR Reading, or Quantitative Reading, when there is a need.  

Third-party reading

DR reading service from a third-party DR reading center is implicated under the following conditions:

  1. For institutions that have the screening reading practice, a contracted third-party service for General DR evaluation (level II reading) is required.
  2. For institutions that third-party service for all DR reading is preferred. Under this circumstance, the routine General DR evaluation (level II reading) for their physicians’ daily clinical practice will be provided by a contracted third-party reading center, in addition to the quantitative readings. Physicians in these institutions will not do the reading work by themselves.
  3. For ETDRS DR grading system (level III reading). ETDRS procedure involves very complicated process, which is impractical for clinical physicians to have it done by themselves. Therefore, the image diagnosis service from a specialized third-party DR reading center is mandatory.