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Systematic screening for diabetic retinopathy with a digital fundus camera following pupillary dilatation in a university diabetes department
Author(s) -
DebJoardar N.,
Germain N.,
Thuret G.,
Garcin A.F.,
Manoli P.,
Defreyn A.,
Gain P.,
Estour B.
Publication year - 2007
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2006.02030.x
Subject(s) - medicine , diabetic retinopathy , diabetes mellitus , fundus photography , mydriasis , retinopathy , fundus (uterus) , ophthalmology , optometry , type 2 diabetes , eye examination , pediatrics , retinal , fluorescein angiography , visual acuity , endocrinology
Aims Screening for diabetic retinopathy (DR) is highly inadequate in France because of insufficient infrastructure and increasing disease prevalence. We describe the results of the first systematic DR screening programme established in a university diabetes department. Methods In this cross‐sectional study conducted over 1 year, consecutive adult patients underwent three‐field retinal photography with the Topcon TRC NW6S digital fundus camera following pupillary dilatation with Tropicamide 1%. A questionnaire provided information on patients’ systemic and ocular history. Glycated haemoglobin (HbA 1c ) was measured at the screening visit. Two ophthalmologists graded the retinal photographs in a masked fashion. Results Of 1157 patients attending the diabetes department, 1153 (99.7%) underwent photographic screening. Images were gradable in 96% patients. Diabetic retinopathy was detected in 522 (45%) patients and sight‐threatening DR in 167 (14%). Of 704 (61%) patients previously believed to have no DR, 254 (34%) screened positive. The presence of DR was associated with age, insulin use and non‐Caucasian ethnicity in Type 2 patients, and with duration of diabetes and HbA 1c in Type 1 and Type 2 patients. Associated ocular pathologies were diagnosed in 612 (53%) patients. Conclusions Our photographic screening programme using pharmacological mydriasis provided a high screening coverage feasible in a hospital setting. We obtained information regarding prevalence and associated risk factors of DR in patients attending a tertiary care centre. Screening was well accepted by patients and met with no protest from city ophthalmologists. It generated considerable interest among endocrinologists and feedback of results is expected to improve optimization of glycaemic control.