Screening for diabetic retinopathy by non‐ophthalmologists: an effective public health tool

Abstract

ABSTRACT.Purpose: To investigate and report the reliability of detection and grading of diabetic retinopathy by direct ophthalmoscopy through a dilated pupil by general physicians (non-ophthalmologists) and optometrists who have undergone a short period of training. Methods: A total of 400 eyes of 200 diabetes patients were examined by two non-ophthalmologists. Their observations were compared with an ophthalmologist's diagnoses for the same patients. Results: The diagnoses made by the general physician (kappa = 0.8381, SE = 0.041) and the optometrist (kappa = 0.7186, SE = 0.051) showed good rates of agreement with the ophthalmologist's diagnoses. Conclusions: The provision of appropriate screening protocols and follow-up parameters can enable primary care physicians and support personnel to reliably screen individuals for retinopathy in diabetes. This will reduce the workload of tertiary hospitals, and provide optimal services to the huge majority of the Indian population that has limited access to eye care services.

Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China

“…Investigators concluded that only 5% of optometrists met the existing standards for DR screening programmes (sensitivity=0.80, specificity=0.95) 28. Our review found little information on the performance of non-medical graders in detection of DR,24 or on grading in LMICs,23 and no prior publications on non-medical graders in LMICs.…”

Retinopathy predicts coronary heart disease mortality

“…Retinopathy lesions (microaneurysms, haemorrhages, cotton wool spots, hard exudates) are well known to doctors, and can be reliably detected using the direct ophthalmoscope available in most emergency departments and doctors’ offices 5. People with diabetes have regular fundus examinations in order to detect sight-threatening retinopathy lesions in a timely manner.…”

Prospective comparison of two methods of screening for diabetic retinopathy by nonmydriatic fundus camera

“…The previous system included the referral of all diabetes patients to the hospital, retinography by a technician, and the study of all images and subsequent reporting by an ophthalmologist 13–15. The inclusion of general practitioners in the screening program might help us to avoid excessive referrals of patients to hospital.…”