Diabetes Care, Vol 16, Issue 6 889-895, Copyright © 1993 by American Diabetes Association

ARTICLES

Screening for diabetic retinopathy. The wide-angle retinal camera

JA Pugh, JM Jacobson, WA Van Heuven, JA Watters, MR Tuley, DR Lairson, RJ Lorimor, AS Kapadia and R Velez
Department of Medicine, University of Texas Health Science Center, San Antonio.

OBJECTIVE--To define the test characteristics of four methods of screening for diabetic retinopathy. RESEARCH DESIGN AND METHODS--Four screening methods (an exam by an ophthalmologist through dilated pupils using direct and indirect ophthalmoscopy, an exam by a physician's assistant through dilated pupils using direct ophthalmoscopy, a single 45 degrees retinal photograph without pharmacological dilation, and a set of three dilated 45 degrees retinal photographs) were compared with a reference standard of stereoscopic 30 degrees retinal photographs of seven standard fields read by a central reading center. Sensitivity, specificity, and positive and negative likelihood ratios were calculated after dichotomizing the retinopathy levels into none and mild nonproliferative versus moderate to severe nonproliferative and proliferative. Two sites were used. All patients with diabetes in a VA hospital outpatient clinic between June 1988 and May 1989 were asked to participate. Patients with diabetes identified from a laboratory list of elevated serum glucose values were recruited from a DOD medical center. RESULTS--The subjects (352) had complete exams excluding the exam by the physician's assistant that was added later. The sensitivities, specificities, and positive and negative likelihood ratios are as follows: ophthalmologist 0.33, 0.99, 72, 0.67; photographs without pharmacological dilation 0.61, 0.85, 4.1, 0.46; dilated photographs 0.81, 0.97, 24, 0.19; and physician's assistant 0.14, 0.99, 12, 0.87. CONCLUSIONS--Fundus photographs taken by the 45 degrees camera through pharmacologically dilated pupils and read by trained readers perform as well as ophthalmologists for detecting diabetic retinopathy. Physician extenders can effectively perform the photography with minimal training but would require more training to perform adequate eye exams. In this older population, many patients did not obtain adequate nonpharmacological dilation for use of the 45 degrees camera.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. P. Rabinowitz, J. E. Grunwald, K. A. Karp, G. E. Quinn, G.-s. Ying, and M. D. Mills Progression to Severe Retinopathy Predicted by Retinal Vessel Diameter Between 31 and 34 Weeks of Postconception Age Arch Ophthalmol, November 1, 2007; 125(11): 1495 - 1500. [Abstract] [Full Text] [PDF]

				M. F. Chiang, J. D. Keenan, J. Starren, Y. E. Du, W. M. Schiff, G. R. Barile, J. Li, R. A. Johnson, D. J. Hess, and J. T. Flynn Accuracy and reliability of remote retinopathy of prematurity diagnosis. Arch Ophthalmol, March 1, 2006; 124(3): 322 - 327. [Abstract] [Full Text] [PDF]

				P. H. Scanlon, C. Foy, R. Malhotra, and S. J. Aldington The Influence of Age, Duration of Diabetes, Cataract, and Pupil Size on Image Quality in Digital Photographic Retinal Screening Diabetes Care, October 1, 2005; 28(10): 2448 - 2453. [Abstract] [Full Text] [PDF]

				D. S. Fong, L. P. Aiello, F. L. Ferris III, and R. Klein Diabetic Retinopathy Diabetes Care, October 1, 2004; 27(10): 2540 - 2553. [Full Text] [PDF]

				H Murgatroyd, A Ellingford, A Cox, M Binnie, J D Ellis, C J MacEwen, and G P Leese Effect of mydriasis and different field strategies on digital image screening of diabetic eye disease Br. J. Ophthalmol., July 1, 2004; 88(7): 920 - 924. [Abstract] [Full Text] [PDF]

				P H Scanlon, R Malhotra, R H Greenwood, S J Aldington, C Foy, M Flatman, and S Downes Comparison of two reference standards in validating two field mydriatic digital photography as a method of screening for diabetic retinopathy Br. J. Ophthalmol., October 1, 2003; 87(10): 1258 - 1263. [Abstract] [Full Text] [PDF]

				P. P. Lee, Z. W. Feldman, J. Ostermann, D. S. Brown, and F. A. Sloan Longitudinal Prevalence of Major Eye Diseases Arch Ophthalmol, September 1, 2003; 121(9): 1303 - 1310. [Abstract] [Full Text] [PDF]

				P. Namperumalsamy, P. K. Nirmalan, and K. Ramasamy Developing a Screening Program to Detect Sight-Threatening Diabetic Retinopathy in South India Diabetes Care, June 1, 2003; 26(6): 1831 - 1835. [Abstract] [Full Text] [PDF]

				F. Gomez-Ulla, M. I. Fernandez, F. Gonzalez, P. Rey, M. Rodriguez, M. J. Rodriguez-Cid, F. F. Casanueva, M. A. Tome, J. Garcia-Tobio, and F. Gude Response to Soto-Pedre et al. Diabetes Care, March 1, 2003; 26(3): 964 - 965. [Full Text] [PDF]

				F. Moller, M. Hansen, and A. K. Sjolie Is One 60{degrees} Fundus Photograph Sufficient for Screening of Proliferative Diabetic Retinopathy? Diabetes Care, December 1, 2001; 24(12): 2083 - 2085. [Abstract] [Full Text] [PDF]

				A. Melville, R. Richardson, J. Mason, A. McIntosh, C. O'Keeffe, J. Peters, and A. Hutchinson Complications of diabetes: screening for retinopathy and management of foot ulcers Qual. Saf. Health Care, June 1, 2000; 9(2): 137 - 141. [Full Text]

				P. Lee Telemedicine: Opportunities and Challenges for the Remote Care of Diabetic Retinopathy Arch Ophthalmol, December 1, 1999; 117(12): 1639 - 1640. [Full Text] [PDF]

				C. Sinthanayothin, J. F Boyce, H. L Cook, and T. H Williamson Automated localisation of the optic disc, fovea, and retinal blood vessels from digital colour fundus images Br. J. Ophthalmol., August 1, 1999; 83(8): 902 - 910. [Abstract] [Full Text]