A Telemedical Approach to the Scre e n i n g of Diabetic Retinopathy: Digital Fundus P h o t o g r a p h y O R I G I N A L A R T I C L E O B J E C T I V E -The importance of screening for diabetic retinopathy has been established, but the best method for screening has not yet been determined. We re p o rt on a trial of assessment of digital photographs by telemedicine compared with standard retinal photographs of the same fields and clinical examination by ophthalmologists. RESEARCH DESIGN AND METHODS-A total of 129 diabetic inpatients were s c reened for diabetic retinopathy by slit-lamp biomicroscopy perf o rmed by an ophthalmologist and by two-field 50° non-stereo digital fundus photographs assessed by six screening centers that received the images by electronic mail. Conventional 35-mm transparencies of the same fields as the digital photographs were assessed by a retinal specialist and served as the re fe rence method for detection of diabetic re t i n o p a t h y. Slit-lamp biomicroscopy was the re f e re n c e method for the detection of macular edema. R E S U LT S -The prevalence of any form of diabetic retinopathy was 30% (n = 35); of sightt h reatening retinopathy including macular edema, the prevalence was 6% (n = 7). The assessment of digital images by the six screening centers resulted in a median sensitivity of 85% and a median specificity of 90% for the detection of moderate nonproliferative or sight-thre a t e ning diabetic re t i n o p a t h y. Clinically significant macular edema (n = 4) was correctly identified in 15 of the 24 grading re p o rts. An additional seven re p o rts re f e rred the patients for furt h e r investigation because of concurrent diabetic re t i n o p a t h y.C O N C L U S I O N S -Te l e s c reening for diabetic retinopathy by an assessment of two-field 50°n o n -s t e reo digital images is a valid screening method. Although detection of clinically significant macular edema using biomicroscopy is superior to digital or standard non-stereo photographs, only few patients with sight-threatening diabetic retinopathy are missed. E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s Diabetes Care 346DIABETES CARE, VOLUME 23, NUMBER 3, MARCH 2000 Telemedical screening of diabetic retinopathyThe 65 patients who did not part i c ipate were older (59.0 ± 16.0 years), had a longer duration of diabetes (17.6 ± 12.4 years), and had more severe re t i n o p a t h y (43% no, 33% mild or moderate, and 24% s i g h t -t h reatening diabetic retinopathy). The p ro p o rtion of men (50%) and patients with type 2 diabetes (58%) did not differ fro m the included patients. These patients were examined by an ophthalmologist only. Experimental protocolAfter the assessment of best corrected visual a c u i t y, each patient was screened for the p resence of diabetic retinopathy after dilation of pupils (tropicamide 1%) and subsequent slit-lamp biomicroscopy by an experienced ophthalmologist. During the study period, six senior ophthalmologists, not specializing in diabetic re t i n o p...

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Diabetic retinopathy is one of the leading causes of blindness in the western world (Munier et al 1998). The challenges for improving the visual prognosis in this disease are comprehensive, and involve a multitude of methodological approaches. Thus, ongoing research programmes are aimed at studying as diverse aspects of diabetic retinopathy as epidemiology, genetics, screening, diagnosis, treatment, and understanding of the pathophysiology of the disease. This review presents the scientific approach followed at Aarhus University Hospital in relation to three of these aspects-epidemiology, computerised grading, and elucidation of the pathophysiology of diabetic retinopathy.