SCREENING FOR DIABETIC-RETINOPATHY - THE UTILITY OF NONMYDRIATIC RETINAL PHOTOGRAPHY IN EGYPTIAN ADULTS

Although regular screening for diabetic retinopathy with ophthalmoscop y or retinal photography is widely recommended in the United States an d Europe, few reports of its use in developing countries are available . We compared the performance of screening by retinal photography with that of indirect ophthalmoscopy by using data from a population-based survey of diabetes and its complications in Egypt. During that projec t, 427 persons with diabetes underwent an eye examination and fundus p hotography with a non-mydriatic camera through a dilated pupil. Data f rom the examinations of the right eye of each patient are presented. N inety-two (22 %) of the 427 retinal photographs were ungradable; in 58 eyes (63 %), this was due to media opacity (42 eyes with cataract, 3 with corneal opacity, and 13 with both). Agreement between retinal pho tography and indirect ophthalmoscopy was poor (kappa = 0.33; 95 % CI = 0.27-0.39) and primarily due to the large number of eyes (n = 79) wit h ungradable photographs that could be graded by ophthalmoscopy. None of these eyes was judged by ophthalmoscopy to have sight-threatening r etinopathy. Fifty-four photographs were diagnosed with greater retinop athy than found on ophthalmoscopy. Retinal photography with the nonmyd riatic camera through a dilated pupil is a useful method to screen for diabetic retinopathy in most adults in Egypt. However, such screening strategies have limited use in older persons and in persons with corn eal disease or cataract. (C) 1998 John Wiley & Sons, Ltd.