SCREENING FOR DIABETIC-RETINOPATHY IN SOUTH-AFRICA WITH 60-DEGREES RETINAL COLOR-PHOTOGRAPHY

Objectives. Comparison of 60 degrees mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, for mal ophthalmological assessment, and with one or two 450 fields. Desig n. Consecutive subjects screened by clinicians and photography, and se lected eyes evaluated by an ophthalmologist. Randomized photographs as sessed through one or two 45 degrees fields (by masking the slides), a nd at 60 degrees. Setting. The first 663 patients attending for routin e clinic visits and screened for retinopathy. Main outcome measures. T he relative diagnostic sensitivity of screening methods, the utility o f screening one eye only, and the costs of photographic screening. Res ults. Compared to an ophthalmologist's assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy , and 100 and 75%, respectively, for severe retinopathy. Photography d etected 28% more retinopathy (16% severe) than the clinicians. Compare d to a 60 degrees field, one 45 degrees field missed 31%, and 2 x 45 d egrees fields 11% of retinopathy. Of 57 patients with retinopathy meet ing referral criteria, 31 pairs of eyes had substantially discordant s cores. The cost of diagnosis in a patient requiring referral to ophtha lmologist was about US$37.00. Conclusions. 60 degrees retinal photogra phy compares well with an ophthalmologists screening, and is better th an clinical and one to two 45 degrees field assessments. Both retinae should be screened. This method is cost-effective in our hands.