Systematic screening for diabetic retinopathy with a digital fundus camera following pupillary dilatation in a university diabetes department

Authors: Deb-Joardar, N.; Germain, N.; Thuret, G.; Garcin, A.-F.; Manoli, P.; Defreyn, A.; Gain, P.; Estour, B.

Source: Diabetic Medicine, Volume 24, Number 3, March 2007 , pp. 303-307(5)

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Abstract:

Aims

Screening for diabetic retinopathy (DR) is highly inadequate in France because of insufficient infrastructure and increasing disease prevalence. We describe the results of the first systematic DR screening programme established in a university diabetes department. Methods

In this cross-sectional study conducted over 1 year, consecutive adult patients underwent three-field retinal photography with the Topcon TRC NW6S digital fundus camera following pupillary dilatation with Tropicamide 1%. A questionnaire provided information on patients' systemic and ocular history. Glycated haemoglobin (HbA_1c) was measured at the screening visit. Two ophthalmologists graded the retinal photographs in a masked fashion. Results

Of 1157 patients attending the diabetes department, 1153 (99.7%) underwent photographic screening. Images were gradable in 96% patients. Diabetic retinopathy was detected in 522 (45%) patients and sight-threatening DR in 167 (14%). Of 704 (61%) patients previously believed to have no DR, 254 (34%) screened positive. The presence of DR was associated with age, insulin use and non-Caucasian ethnicity in Type 2 patients, and with duration of diabetes and HbA_1c in Type 1 and Type 2 patients. Associated ocular pathologies were diagnosed in 612 (53%) patients. Conclusions

Our photographic screening programme using pharmacological mydriasis provided a high screening coverage feasible in a hospital setting. We obtained information regarding prevalence and associated risk factors of DR in patients attending a tertiary care centre. Screening was well accepted by patients and met with no protest from city ophthalmologists. It generated considerable interest among endocrinologists and feedback of results is expected to improve optimization of glycaemic control.

Diabet. Med. 24, 303-307 (2007)

Keywords: diabetic retinopathy; health services research; mass screening; mydriasis; photography

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1464-5491.2006.02030.x

Affiliations: 1: Endocrinology, University Hospital Bellevue, Saint-Etienne, France

Publication date: 2007-03-01