Infections that last

August 2009

Research

Diabetic retinopathy screening in general practice

A pilot study

Volume 38, No.8, August 2009 Pages 650-656

Deborah A Askew

Philip J Schluter

Geoffrey Spurling

Clare M Maher

Peter Cranstoun

Craig Kennedy

Claire Jackson

Background

Early detection and treatment of diabetic retinopathy (DR) can prevent nearly all associated severe vision loss. We investigated the feasibility of DR screening using nonmydriatic cameras in two Australian primary care clinics.

Methods

Two general practitioners from Queensland photographed the retinas of patients with type 2 diabetes seen in their clinics during the 9 month study period. The patients were then photographed and assessed by two independent ophthalmologists. The ophthalmologists’ assessments provided the reference standard. General practitioners’ accuracy in determining photograph interpretability and DR diagnostic sensitivity and specificity were measured. The attitudes of GPs about the DR screening were also assessed.

Results

One hundred and fourteen patient participants provided 219 photographs. Two ophthalmologists read 158 photographs and deemed 61% (97/158) interpretable, but GPs tended to accept more photographs for interpretation. General practitioners’ diagnostic sensitivity and specificity was 87% and 95% respectively. Participating GPs were very positive about expanding their clinical role into DR screening.

Discussion

General practice based DR screening was feasible and acceptable in the clinics studied, but photograph quality was an issue.

Type 2 diabetes mellitus (T2DM) is a serious chronic disease worldwide, resulting in significant personal, social and economic costs.1 Approximately 850 000 Australians have T2DM, and based on results from four major Australian epidemiological studies, it is estimated that 25–35% of these have diabetic retinopathy (DR).2 Diabetic retinopathy is the leading cause of preventable blindness in adults.3 Early detection and appropriate treatment can prevent nearly all severe vision loss and blindness from DR.4

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Correspondence afp@racgp.org.au

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