COMPARISON OF DIABETIC-RETINOPATHY DETECTION BY CLINICAL EXAMINATIONSAND PHOTOGRAPH GRADINGS

Objective: To compare the use of clinical examination and fundus photo graph gradings in detecting diabetic retinopathy in a population that includes persons with and without diabetes. Design: Population-based e pidemiologic study. Setting: Sir Winston Scott Polyclinic, Bridgetown, Barbados, West indies. Participants: Subset of a random sample of the country's population aged 40 to 86 years. Results: Among 1168 black p ersons with fundus photograph evaluations, ophthalmologic examinations , diabetes history, and glycated hemoglobin data, 21% reported a histo ry of diabetes; 9.5% had definite diabetes (glycated hemoglobin >11.5% ); and 13.3% had a diabetes history and glycated hemoglobin value less than or equal to 11.5%. The frequency of diabetic retinopathy in this group was 7.7% (90/1168) by clinical examination, 8.7% (102/1168) by photograph gradings, and 6.7% (78/1168) by both methods. Conclusions: These results suggest that in certain populations that include diabeti cs and nondiabetics, a clinical examination by an ophthalmologist will detect most cases of diabetic retinopathy identified by disc and macu la photographs read by skilled graders. However, it will lead to an un derestimate of prevalence. Staff availability .and cost, issues not ex amined in this study, should determine which approach is selected.