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oa Journal of Endocrinology, Metabolism and Diabetes in South Africa - Effective and accurate screening for diabetic retinopathy using a 60o mydriatic fundus camera

 

Abstract

&lt;i&gt;Objectives.&lt;/i&gt; To establish whether an experienced endocrinologist could screen accurately for diabetic retinopathy using mydriatic 60&lt;sup&gt;o&lt;/sup&gt; fundus photographs compared with a reference standard, viz. the combined highest scores of two experienced ophthalmologists. &lt;br&gt;&lt;i&gt;Design.&lt;/i&gt; Retrospective review of 60&lt;sup&gt;o&lt;/sup&gt; colour transparency photographs taken over a 6-year period. Retinopathy was graded in a standardised way. &lt;br&gt;&lt;i&gt;Setting.&lt;/i&gt; Patients attending the diabetic clinic at Johannesburg Hospital, South Africa. &lt;br&gt;&lt;i&gt;Subjects.&lt;/i&gt; 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.&lt;/i&gt; 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. &lt;br&gt;&lt;i&gt;Results.&lt;/i&gt; 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. &lt;br&gt;&lt;i&gt;Conclusions.&lt;/i&gt; 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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/content/m_jemdsa/10/1/EJC64096
2005-04-01
2016-12-05
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