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Screening for diabetic retinopathy in South Africa with 60° retinal colour photography
Author(s) -
JOANNOU J.,
KALK W. J.,
NTSEPO S.,
BERZIN M.,
JOFFE B. I.,
RAAL F. J.,
SACHS E.,
VAN DER MERWE M. T.,
WING J. R.,
MAHOMED I.
Publication year - 1996
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.1996.413755000.x
Subject(s) - medicine , diabetic retinopathy , retinopathy , referral , fundus photography , optometry , ophthalmology , retinal , photography , eye disease , diabetes mellitus , fluorescein angiography , family medicine , art , visual arts , endocrinology
Objectives. Comparison of 60° mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45° fields. Design. Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45° fields (by masking the slides), and at 60°. Setting. The first 663 patients attending for routine clinic visits and screened for retinopathy. Main outcome measures. The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening. Results. Compared to an ophthalmologist’s assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60° field, one 45° field missed 31%, and 2×45° fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US$37.00. Conclusions. 60° retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45° field assessments. Both retinae should be screened. This method is cost‐effective in our hands.