Diabetic Retinopathy as Detected Using Ophthalmoscopy, a Nonmyciriatic Camera and a Standard Fundus Camera

Klein, Ronald; Klein, Barbara E. K.; Neider, Michael W.; Hubbard, Larry D.; Meuer, Stagy M.; Brothers, Rosemary J.

doi:10.1016/s0161-6420(85)34003-4

Cited by 221 publications

(121 citation statements)

References 5 publications

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“…6 When using standard direct ophthalmoscopy without dilation, even those experienced in ophthalmoscopy have rates for correct assessment of only about 50%. 9 There are several limitations that must be considered in interpreting the results of this study. First, we evaluated accuracy after 1 training workshop and 1 month of practice; it is likely that physicians would probably be more accurate after using the tools for a longer period.…”

Section: Discussionmentioning

confidence: 95%

Accuracy of Screening for Diabetic Retinopathy by Family Physicians

Gill

Cole²,

Lebowitz³

et al. 2004

The Annals of Family Medicine

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BACKGROUND We wanted to examine the accuracy of family physicians' screening for diabetic retinopathy using standardized criteria and a nonmydriatic ophthalmoscope. METHODSEleven family physicians assessed 28 standardized patients with diabetes mellitus using the PanOptic ophthalmoscope. Their assessments of whether the patients required referral to an ophthalmologist were compared with the reference standard of retinal diagrams. RESULTSThe mean sensitivity for the family physicians was 87% (95% confidence interval [CI], 83%-91%) with a specifi city of 57% (95% CI, 46%-68%). Overall agreement was moderate, with a mean = .43 (95% CI, 0.39%-0.47%).CONCLUSIONS Using standardized criteria and a nonmydriatic ophthalmoscope, family physicians were fairly accurate in screening patients for diabetic retinopathy. Whereas this technique is not suffi ciently accurate to replace routine referral for all patients with diabetes, it can be used to improve care for those patients who fail to get routine eye screenings.

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Section: Discussionmentioning

confidence: 95%

Accuracy of Screening for Diabetic Retinopathy by Family Physicians

Gill

Cole²,

Lebowitz³

et al. 2004

The Annals of Family Medicine

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“…This paper is therefore likely to provide a low estimate of true incidence. Direct ophthalmoscopy as used in this study is less sensitive and specific than the retinal photographic methods which have come to be the`gold standard' for epidemiological surveys of diabetic retinopathy [22,37]. To optimise comparability, our fundus examinations were carried out by skilled and experienced (u of c) = units of change *p < 0.05; **p < 0.01; a 0-female, 1-male; b 0 = no, 1 = yes; c 0 = Type II, 1 = Type I diabetes local professionals, its methodology was specified in detail, and abnormalities found were documented using a simple, interpretation-free description of lesions [12].…”

Section: Discussionmentioning

confidence: 99%

The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes

et al. 2001

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Aims/hypothesis. We aimed to estimate incidences of any retinopathy and proliferative diabetic retinopathy (PDR) by direct ophthalmoscopy and relate them to baseline risk factors in re-examined diabetic survivors from 10 centres of the WHO Multinational Study of Vascular Disease in Diabetes. Methods. After a mean follow-up of 8.4 years (11.7 years in Oklahoma), 2877 (71.6 %) survivors were resubmitted to standardised direct ophthalmoscopy as at baseline. The presence of any retinopathy and PDR were recorded at each centre and their incidence estimated in those without retinopathy and PDR at baseline. The independent associations of these incidences with baseline risk factors are expressed as odds ratios derived from multiple logistic regression analyses, within individual centres (which included fasting plasma glucose in 8 and triglyceride in 5) and in pooled data. Results. Of the 4662 original patients, 465 (10.4 %) of those without and 77 (43.0 %) of those with baseline PDR had died (p < 0.001). Any retinopathy was newly reported at follow-up in 47.7 % and PDR in 9.7 % of those free of them at baseline, with reported incidences varying substantially among centres. Incident retinopathy appeared earlier in the known course of diabetes but incidence rates rose more slowly with duration in patients with Type II (non-insulin-dependent) diabetes mellitus than in those with Type I (insulin-dependent) diabetes mellitus. In pooled data and in some individual centres, any retinopathy incidence gave significantly positive odds ratios with age, diabetes duration, systolic pressure, plasma cholesterol, BMI, insulin treatment and proteinuria, and with fasting plasma glucose in the centres where it was measured. Positive odds ratios for PDR were similarly obtained for age, duration, insulin treatment, cholesterol, proteinuria and fasting glycaemia. Smoking status odds ratios were negative for both outcomes. Conclusion/interpretation. Incidence of ophthalmoscopically ascertained any retinopathy varied about twofold and of PDR about threefold among centres. Although, in part attributable to differences between observers, variation in incidence in all centres and in some cases within centres was associated with a number of baseline risk factors. Such associations are not likely due to observer variation or selection biases and emerged despite the imprecision of clinical ophthalmoscopy. Improved detection and control of these risk factors should reduce the impact of diabetic retinopathy and its consequences. [Diabetologia (2001)

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“…Moss and his co-workers (1989) showed that the sensitivity for detecting proliferative changes was 74% when the assessment of retinopathy was based on two 30ae fields (standard fields 1 and 2), as compared to 90% when the assessment was based on four 30ae fields (standard fields 1,2,3,4, or 1,2,4,5). Furthermore, according to reports from the Wisconsin studies, 27% of the neovascular lesions occurred outside one 45ae photographic field centred between the disc and the fovea (Klein et al 1985). In the same way Barrie and MacCuish (1986) have presented a case report with extensive neovascularisations outside the area covered by two 45ae photographic fields.…”

Section: Discussionmentioning

confidence: 86%

A comparison between one‐ and two‐field 60° fundus photography when screening for diabetic retinopathy

Wendt¹,

Rönnholm²,

Heikkilä³

et al. 2000

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To compare the severity level of diabetic retinopathy obtained when assessed from two versus only one 60ae photographic field using colour transparencies and red-free, black-and-white photographs. To compare the areal coverage of these two photographic strategies to that of seven-field 30ae photography. Methods: Two ophthalmologists graded photographs of 74 eyes of 74 type I and II diabetes patients. Inter-method agreement was expressed in percentages and using kappa statistics and scatter-diagrams. The comparison of the approximate photographic areal coverage was done from diagrams using planimetry. Results: The severity level of retinopathy when judged from two photographic fields was more severe in 13.5% (Grader 1) and in 16.2% (Grader 2) from colour transparencies and in 13.5% (Grader 1) and in 14.9% (Grader 2) from red-free black-and-white prints, as compared to assessments from only one field. Kappa values (0.84-0.86) for inter-method agreement for five pooled retinopathy levels revealed good agreement. Neither grader missed retinopathy requiring clinical assessment or treatment (levels Ø47) when minimal retinopathy (levels 14-20) was detected using only one 60ae colour slide or red-free photograph. A second optic disc-centred field provided valuable additional information when more severe retinopathy lesions (levels Ø30) were detected in the macula-centred field. One macula-centred 60ae photograph covered 60% and two 60ae photographs 80% of the area covered by seven-field 30ae photography. Two-field 60ae photography covers areas left outside seven-field 30ae photography. Conclusion:We propose the use of one macula-centred 60ae photograph when screening for the first lesions of diabetic retinopathy. After they have been found two-field 60ae photography is recommended.

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Diabetic Retinopathy as Detected Using Ophthalmoscopy, a Nonmyciriatic Camera and a Standard Fundus Camera

Cited by 221 publications

References 5 publications

Accuracy of Screening for Diabetic Retinopathy by Family Physicians

Accuracy of Screening for Diabetic Retinopathy by Family Physicians

The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes

A comparison between one‐ and two‐field 60° fundus photography when screening for diabetic retinopathy

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