Table 3.
Skill Based Skill-based competence levels for people involved in taking retinal photograph
| Level 1 | Level 2 | Level 3 | |
|---|---|---|---|
| Basics | |||
| Knowledge on DR* | Basic Knowledge of 1. DR 2. Grading 3. Complications of DR | Detailed Knowledge of 1. DR 2. Grading 3. Complications of DR | Basic Knowledge of Grading & Management |
| About Retinal Photography | Basic Knowledge about how to perform Fundus Photography | Fairly good idea on Fundus Photography, handling the machine including the optics & adjusting the illumination | Detailed knowledge on Fundus Photography, handling the machine including the optics & adjusting the illumination |
| About FFA† | Basic Knowledge about how to perform FFA. | Detailed Knowledge about performing FFA, concentration & techniques on injecting the dye, positioning the camera & the patient. | Comprehensive knowledge on performing FFA & FFA interpretation |
| About Complications | Basic Knowledge about complications of FFA. | Detailed Knowledge about complications of FFA & the treatment. | Comprehensive Knowledge on complications & its management; & ability to administer Emergency First Aid Management |
| Counseling | Can explain regarding the procedure to the patient | Can explain regarding the procedure to the patient including complications. | Can explain regarding the procedure to the patient including complications. |
| Procedure Related | |||
| Patient Records (EMR)‡ | Can create an EMR/paper record but with slight difficulty and takes additional time | Can create EMR/paper record without any difficulty | Can create an good EMR record/paper and can also access the old EMR records with ease |
| Quality of image (non mydriatic) | Minimum 70% images in focus | 70%-90% images in focus | >90% image in focus |
| Quality of image (mydriatic) | Minimum 70% images in focus | 70%-90% images in focus | >90% image in focus |
| Focussing the lesions | Unable to identify and focus on specific lesions | Able to identify and focus on specific lesion | Identifies and takes a well-focused images of specific lesions |
| quality and ability to perform stereoscopic images | Unable to perform stereoscopic images | Able to perform stereoscopic images | Produces good stereoscopic images |
| Speed of imaging | Completes imaging of reasonable quality in <20 min | Completes imaging in <15 min | Completes imaging in<10 mins |
| Post image capturing | |||
| Basic life support | Unable to administer | Has knowledge about BLS§ | Had adequate knowledge and ability to perform BLS |
| Image grading and reporting | Can only identify few lesions in DR | Can identify lesion and grade DR | Can grade DR as well as identify few lesions on FFA |
| Identify diabetic retinopathy | Can only identify few lesions | Can identify most of the lesions | Can identify all the lesion and refer the patients if required |
| Grade diabetic retinopathy | Cannot grade DR | Can Grade presence or absence of DR | Can identify grades of DR |
| Identify phases of fluorescein angiography | Cannot identify | Can identify | Can identify |
| Ability to differentiate STDR||/Non STDR | Not able to differentiate | Not able to differentiate | Able to identify STDR/Non STDR |
| Ability to monitor disease progression | Not able to do | Not able to do | Able to monitor the progression of the disease adequately |
| Take decision regarding referral | Not able to make decisions of referral | Able to make decision on referral of DR | Able to refer STDR confidently |
| Post-Procedure | |||
| Image handling | Keeps all the images without making any changes | Keeps all the images without making any changes | Able to identify only the required images and deletes the unnecessary ones |
| Records | Able to keep archival database of images | Able to keep the database and take back-ups too | Able to keep the database and take back-ups too |
| Follow up | Not able take decisions regarding the follow-up | Is able to instruct follow-up advice for NO DR cases | Is able to instruct follow-up advice for NO DR and STDR cases |
| Complication management | Unable to manage complication | Has knowledge about the complications and its management | Has knowledge about the complication and management and able to perform basic procedures if required |
*DR- Diabetic Retinopathy, †FFA- Fundus Fluorescein Angiography, ‡EMR-Electronic Medical Records, §BLS-Basic Life Support, ||STDR-Sight Threatening Diabetic Retinopathy