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. 2022 Sep 9;12(9):e059205. doi: 10.1136/bmjopen-2021-059205

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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Flow diagram to illustrate enrolment of patients and management of images in phase I from August to October 2018 (initial grading performance analysis). Level 1 and level 2 graders graded the same set of photographs and level 3 graders graded a subset of these photographs: all disagreements between level 1 and 2 graders and a 40% random sample of all images. DMO, diabetic macular oedema; DR, diabetic retinopathy.