THE DIAGNOSIS OF DIABETIC-RETINOPATHY - OPHTHALMOSCOPY VERSUS FUNDUS PHOTOGRAPHY

Purpose: To compare fundus photography with ophthalmoscopy in the dete ction of diabetic retinopathy. Methods: Ophthalmoscopy and fundus phot ographs with a nonmydriatic camera, both performed through dilated pup ils, were compared to diagnose retinopathy in a cohort of 410 Oklahoma Indians with noninsulin-dependent diabetes mellitus. A total of 795 e yes were examined using both methods. The mean age of participants was 60.3 years, with a mean duration of diabetes of 17.3 years. Results: An overall agreement of 86.3% with a kappa statistic K of 0.74 was fou nd between ophthalmoscopy and fundus photography with a nonmydriatic c amera. For the diagnosis of proliferative diabetic retinopathy, K = 0. 84 with an agreement of 98.1%. With a total of 61 cases of proliferati ve retinopathy diagnosed by either method in our study, ophthalmoscopy alone detected 88.5% and fundus photography, 78.7%. When compared on a lesion-by-lesion basis, agreement between the two diagnostic methods was highest for nonproliferative retinopathy, as well as fibrous prol iferation. Conclusion: The fundus photography with a nonmydriatic came ra, performed with mydriasis, is comparable to ophthalmoscopy for the detection of retinopathy. It may prove to be a suitable, cost-effectiv e method for routine screening in diabetes clinics, provided ophthalmo logic referral is ensured for those with a diagnosis of any form of re tinopathy, questionable retinopathy, nondiabetic retinopathy, those wi th poor quality photographs, as well as those with acute changes in vi sual acuity .