SCREENING FOR DIABETIC-RETINOPATHY

Objectives: To identify factors associated with a high risk of diabeti c retinopathy in order to rank patients for urgency of examination by fundal photography. Design: Retrospective case survey. Patients: Eight hundred and eighty-eight consecutive diabetic patients who were routi nely referred for mydriatic fundal photography to the Queen Elizabeth Hospital, Adelaide, between August 1987 and May 1992. Outcome measures : The prevalence of non-proliferative and proliferative diabetic retin opathy, and patient biochemical and demographic characteristics and ur inary albumin excretion rate. Results: The prevalences of nonprolifera tive and proliferative diabetic retinopathy were 18.1% and 2.4%, respe ctively. Multiple logistic regression analysis established that treatm ent with insulin or oral hypoglycaemic drugs was associated with the h ighest risk of diabetic retinopathy (odds ratio [OR], 14.7; 95% confid ence interval [CI], 3.4-63.2), while duration of diabetes greater than or equal to 7 years (OR, 3.6; 95% CI, 1.9-6.8), age 50-66 years (OR, 2.1; 95% CI, 1.1-4.0) and albumin excretion rate greater than or equal to 21 mu g/min (OR, 2.2; 95% CI, 1.1-4.5) were also significant risk factors. Non-significant variables were hypertension, obesity and sex. Conclusions: Diabetic patients may be ranked for urgency of retinal p hotographic screening based on mode of treatment and duration of diabe tes, thereby facilitating examination of patients at highest risk of a symptomatic diabetic retinopathy and increasing the efficiency of the screening program.