Screening for diabetic retinopathy in South Africa with 60[degrees] retinal colour photography.
JOANNOU, J.; KALK, W. J.; MAHOMED, I. 1; NTSEPO, S.; BERZIN, M.; JOFFE, B. I.; RAAL, F. J.; SACHS, E.; VAN DER MERWE, M. T.; WING, J. R.
[Article] Journal of Internal Medicine. 239(1):43-47, January 1996.

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Objectives: Comparison of 60[degrees] mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45[degrees] fields.

Design: Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45[degrees] fields (by masking the slides), and at 60[degrees].

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[degrees] field, one 45[degrees] field missed 31%, and 2 x 45[degrees] 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[degrees] retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45[degrees] field assessments. Both retinae should be screened. This method is cost-effective in our hands.

(C) 1996 Blackwell Science Ltd.