The diagnosis of diabetic retinopathy. Ophthalmoscopy versus fundus photography.
OBJECTIVE
To compare fundus photography with ophthalmoscopy in the detection of diabetic retinopathy.


METHODS
Ophthalmoscopy and fundus photographs with a nonmydriatic camera, both performed through dilated pupils, were compared to diagnose retinopathy in a cohort of 410 Oklahoma Indians with noninsulin-dependent diabetes mellitus. A total of 795 eyes were examined using both methods. The mean age of participants was 60.3 years, with a mean duration of diabetes of 17.3 years.


RESULTS
An overall agreement of 86.3% with a kappa statistic kappa of 0.74 was found between ophthalmoscopy and fundus photography with a nonmydriatic camera. For the diagnosis of proliferative diabetic retinopathy, kappa = 0.84 with an agreement of 98.1%. With a total of 61 cases of proliferative retinopathy diagnosed by either method in our study, ophthalmoscopy alone detected 88.5% and fundus photography, 78.7%. When compared on a lesion-by-lesion basis, agreement between the two diagnostic methods was highest for nonproliferative retinopathy, as well as fibrous proliferation.


CONCLUSIONS
The fundus photography with a nonmydriatic camera, performed with mydriasis, is comparable to ophthalmoscopy for the detection of retinopathy. It may prove to be a suitable, cost-effective method for routine screening in diabetes clinics, provided ophthalmologic referral is ensured for those with a diagnosis of any form of retinopathy, questionable retinopathy, nondiabetic retinopathy, those with poor quality photographs, as well as those with acute changes in visual acuity.
Lee
V S
VS
Department of Radiology, Duke University Medical School, Durham.
Kingsley
R M
RM
Lee
E T
ET
Lu
M
M
Russell
D
D
Asal
N R
NR
Bradford
R H
RH
Wilkinson
C P
CP
D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000208:ethnology*; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009825:Oklahoma; D009887:Ophthalmoscopy; D010781:Photography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity