Purpose: To evaluate the sensitivity and specificity of one-field, non-mydriatic, 45° digital photography for screening for diabetic retinopathy compared to indirect ophthalmoscopy using a slit-lamp, the reference standard. Methods: A total of 100 consecutive diabetic patients (200 eyes) who underwent digital fundus photography and ocular examinations from June 2002 to November 2002 were included in this retrospective study. The patients, recruited from a hospital-based, retina referral practice, underwent 45°, non-mydriatic, digital fundus photography using a non-mydriatic fundus camera. One image was obtained focusing the mid fundus between the optic disc and the macula. The fundus images were printed and graded by endocrinologists and a retinal specialist separately. The patients also underwent complete standard ocular examinations as the reference method for determining diabetic retinopathy, including dilation of their pupils and slit-lamp biomicroscopy done by ophthalmologists. The sensitivity and specificity of the digital photographic method were calculated by comparison to the reference method. Results: The sensitivity and specificity of the retinal specialist’s diabetic retinopathy grades were 53.8 and 89.0%, respectively. The sensitivity and specificity of the endocrinologists’ grades were 45 and 75.3%, respectively. The false negative rates were 22 and 21.5% for endocrinologists and the retinal specialist, respectively. Conclusions: Screening for diabetic retinopathy using one-field, non-mydriatic, 45° digital photography is inadequate.

1.
Patz A, Smith RE: The ETDRS and Diabetes 2000. Ophthalmology 1991;98:739–740.
2.
Javitt JC, Aiello LP: Cost effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996;124:164–169.
3.
Diabetes Control and Complications Trial Research Group: The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus. Arch Ophthalmol 1995;113:36–51.
4.
United Kingdom Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998;352:837–853.
5.
Backlund LB, Algvere PV, Rosenqvist U: Early detection of diabetic retinopathy by a mobile retinal photography service in partnership with primary health care teams. Diabet Med 1998;15(suppl 3):S32–S37.
6.
Klein R: Barriers to prevention of vision loss caused by diabetic retinopathy. Arch Ophthalmol 1997;115:1073–1074.
7.
British Diabetic Association: Retinal photographic screening for diabetic eye disease. A British Diabetic Association Report, London 1997.
8.
Herbert HM, Jordan K, Flanagan DW: Is screening with digital imaging using one retinal view adequate? Eye 2003;17:497–500.
9.
Younis N, Broadbent DM, Jamest M, Harding SP, Vora JP: Current status of screening for diabetic retinopathy in the UK. Diabet Med 2002;19(suppl 4):44–49.
10.
Scanlon PH, Malhotra R, Thomas G, Foy C, Kirkpatrick JN, Lewis-Barned N, Harney B, Aldington SJ: The effectiveness of screening for diabetic retinopathy by digital imaging photography and technician ophthalmoscopy. Diabet Med 2003;20:467–474.
11.
Aldington AJ, Kohner EM, Meuer S, Klein R, Sjolie AK: Methodology for retinal photography and assessment of diabetic retinopathy: The EURODIAB IDDM Complications Study. Diabetologia 1995;38:437–444.
12.
Buxton MJ, Sculpher MJ, Ferguson BA, Humphreys JE, Altman JFB, Spiegelhalter DJ, Kirby AJ, Jacob JS, Bascon H, Dudbridge SB, Stead JW, Feest TG, Cheng H, Franklin SL, Courtney P, Talbot JF, Ahmed R, Dabbs TR: Screening for treatable diabetic retinopathy: A comparison of different methods. Diabet Med 1991;8:371–377.
13.
Harding SP, Broadbent DM, Neon C, White MC, Vora J: Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: The Liverpool Diabetic Eye Study. Br Med J 1995;311:1131–1135.
14.
Gillow JT, Muir Gray JA: The National Screening Committee review of diabetic retinopathy screening. Eye 2001;15:1–2.
15.
Heaven CJ, Cansfield J, Shaw KM: The quality of photographs produced by the non-mydriatic fundus camera in a screening programme for diabetic retinopathy: A 1-year prospective study. Eye 1993;7:787–790.
16.
Penman AD, Saaddine JB, Hegazy M, Sous ES, Ali MA, Brechner RJ, Herman WH, Engelgau MM, Klein R: Screening for diabetic retinopathy: the utility of nonmydriatic retinal photography in Egyptian adults. Diabet Med 1998;15:783–787.
17.
George LD, Halliwell M, Hill R, Aldington SJ, Lusty J, Dunstan F, Owens DR: A comparison of digital retinal images and 35-mm color transparencies in detecting and grading diabetic retinopathy. Diabet Med 1998;15:250–253.
18.
Olson JA, Strachan FM, Hipwell JH, Goatman KA, McHardy KC, Forrester JV, Sharp PF: A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. Diabet Med 2003;20:528–534.
19.
Stellingwerf C, Hardus P, Hooymans J: Two-field photography can identify patients with vision-threatening diabetic retinopathy: A screening approach in the primary care setting. Diabetes Care 2001;24:2086–2090.
20.
Ryder REJ, Kong N, Bates AS, Sim J, Welch J, Kritzinger EE: Instant electronic imaging systems are superior to Polaroid at detecting sight-threatening diabetic retinopathy. Diabet Med 1998;15:254–258.
21.
Lim JI, LaBree L, Nichols T, Cardenas I: A comparison of digital nonmydriatic fundus imagings and standard 35-mm slides for diabetic retinopathy. Ophthalmology 2000;107:866–870.
22.
George LD, Lusty J, Owens DR, Ollerton RL: Effect of software manipulation (Photoshop) of digitized retinal images on the grading of diabetic retinopathy. Br J Ophthalmol 1999;83:911–913.
23.
Newson RSB, Clover A, Costen MTJ, Sadler J, Newton J, Luff AJ, Canning CR: Effect of digital image compression on screening for diabetic retinopathy. Br J Ophthalmol 2001;85:799–802.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.