Comparison of diabetic retinopathy detection by clinical examinations and photograph gradings. Barbados (West Indies) Eye Study Group.
OBJECTIVE
To compare the use of clinical examination and fundus photograph gradings in detecting diabetic retinopathy in a population that includes persons with and without diabetes.


METHODS
Population-based epidemiologic study.


METHODS
Sir Winston Scott Polyclinic, Bridgetown, Barbados, West Indies.


METHODS
Subset of a random sample of the country's population aged 40 to 86 years.


RESULTS
Among 1168 black persons with fundus photograph evaluations, ophthalmologic examinations, diabetes history, and glycated hemoglobin data, 21% reported a history of diabetes; 9.5% had definite diabetes (glycated hemoglobin > 11.5%); and 13.3% had a diabetes history and glycated hemoglobin value less than or equal to 11.5%. The frequency of diabetic retinopathy in this group was 7.7% (90/1168) by clinical examination, 8.7% (102/1168) by photograph gradings, and 6.7% (78/1168) by both methods.


CONCLUSIONS
These results suggest that in certain populations that include diabetics and nondiabetics, a clinical examination by an ophthalmologist will detect most cases of diabetic retinopathy identified by disc and macula photographs read by skilled graders. However, it will lead to an underestimate of prevalence. Staff availability and cost, issues not examined in this study, should determine which approach is selected.
Schachat
A P
AP
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.
Hyman
L
L
Leske
M C
MC
Connell
A M
AM
Hiner
C
C
Javornik
N
N
Alexander
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001460:Barbados / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods*; D011897:Random Allocation