oa Journal of Endocrinology, Metabolism and Diabetes in South Africa - Effective and accurate screening for diabetic retinopathy using a 60o mydriatic fundus camera
<i>Objectives.</i> To establish whether an experienced endocrinologist could screen accurately for diabetic retinopathy using mydriatic 60<sup>o</sup> fundus photographs compared with a reference standard, viz. the combined highest scores of two experienced ophthalmologists. <br><i>Design.</i> Retrospective review of 60<sup>o</sup> colour transparency photographs taken over a 6-year period. Retinopathy was graded in a standardised way. <br><i>Setting.</i> Patients attending the diabetic clinic at Johannesburg Hospital, South Africa. <br><i>Subjects.</i> Fifteen hundred and seventeen patients (2 446 eyes) formed the basis for the study. Patients were included if there was more than 50% readability of the fundus photographs. <br><i>Outcome measures.</i> Outcome measures were prevalence of any retinopathy and presence of referable (severe) retinopathy. Inter-observer agreement was measured using the kappa statistic, and sensitivity and specificity of the screener were evaluated. <br><i>Results.</i> The prevalence of retinopathy at the clinic was approximately 30%, but only about 12% was severe enough to warrant referral to the ophthalmology outpatient department. The endocrinologist was very accurate in determining cases requiring referral; there was 97% agreement with the reference standard, viz. the combined highest score of two experienced ophthalmologists (gold standard). Correlation on the determination of any retinopathy was less accurate (80% agreement), mostly owing to the endocrinologist reporting more isolated microaneurysms than the ophthalmologists. The screening method used gave a sensitivity of 83% and specificity of 99% which are within recommended standards. <br><i>Conclusions.</i> The screening strategy using a mydriatic fundus camera at the diabetic clinic was found to be effective and accurate and greatly reduced the number of possible referrals to the ophthalmology outpatient department.
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