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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 illustrating the enrolment of patients and management of images included in phase II from January 2020 to October 2020 (follow-up grading performance analysis after retraining). Level 1 and level 2 graders graded the same set of photographs and level 3 graders graded a subset of these images. DMO, diabetic macular oedema; DR, diabetic retinopathy.