ADDING RETINAL PHOTOGRAPHY TO SCREENING FOR DIABETIC-RETINOPATHY - A PROSPECTIVE-STUDY IN PRIMARY-CARE

Objective-To evaluate whether adding retinal photography improved comm unity screening for diabetic retinopathy. Setting-Mobile screening uni t at rural and urban general practices in south west England. Subjects -1010 diabetic patients from primary care. Design-Prospective study; p atients were examined by ophthalmoscopy by general practitioners or op ticians without fundal photographs and again with photographs, and ass essments were compared to those of an ophthalmologist. Main outcome me asures-Whether fundal photography improved the sensitivity of detectio n of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by t he specialist. Results-Diabetic retinopathy was detected by the ophtha lmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4. 9%). The sensitivity of the general practitioners and opticians for re ferrable retinopathy with ophthalmoscopy was 65% and improved to 84% w ith retinal photographs. General practitioners' sensitivity in detecti ng background retinopathy improved with photographs from 22% to 65%; o pticians' sensitivity in detecting background retinopathy improved fro m 43% to 71%. The sensitivity of detecting referrable retinopathy by g eneral practitioners improved from 56% to 80% with photographs; for op ticians it improved from 75% to 88%. Conclusion-Combining modalities o f screening by providing photography with specialist review of all fil ms in addition to direct ophthalmoscopy through dilated pupils improve s assessment and referral for diabetic retinopathy by general practiti oners and opticians. With further training and experience, primary car e screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening pro gramme for this condition.