title: Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care.
abstract: OBJECTIVE
  To evaluate whether adding retinal photography improved community screening for diabetic retinopathy.
  
  
  METHODS
  Mobile screening unit at rural and urban general practices in south west England.
  
  
  METHODS
  1010 diabetic patients from primary care.
  
  
  METHODS
  Prospective study; patients were examined by ophthalmoscopy by general practitioners or opticians without fundal photographs and again with photographs, and assessments were compared to those of an ophthalmologist.
  
  
  METHODS
  Whether fundal photography improved the sensitivity of detection of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by the specialist.
  
  
  RESULTS
  Diabetic retinopathy was detected by the ophthalmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4.9%). The sensitivity of the general practitioners and opticians for referrable retinopathy with ophthalmoscopy was 65%, and improved to 84% with retinal photographs. General practitioners' sensitivity in detecting background retinopathy improved with photographs from 22% to 65%; opticians' sensitivity in detecting background retinopathy improved from 43% to 71%. The sensitivity of detecting referrable retinopathy by general practitioners improved from 56% to 80% with photographs; for opticians it improved from 75% to 88%.
  
  
  CONCLUSIONS
  Combining modalities of screening by providing photography with specialist review of all films in addition to direct ophthalmoscopy through dilated pupils improves assessment and referral for diabetic retinopathy by general practitioners and opticians. With further training and experience, primary care screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening programme for this condition.
authors.affiliation: Department of Medicine, Royal United Hospital, Bath.
authors.forename: J P
authors.initials: JP
authors.lastname: O'Hare
authors.forename: A
authors.initials: A
authors.lastname: Hopper
authors.forename: C
authors.initials: C
authors.lastname: Madhaven
authors.forename: M
authors.initials: M
authors.lastname: Charny
authors.forename: T S
authors.initials: TS
authors.lastname: Purewell
authors.forename: B
authors.initials: B
authors.lastname: Harney
authors.forename: J
authors.initials: J
authors.lastname: Griffiths
mesh_terms: D000553:Ambulatory Care; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000517:prevention & control*; D005194:Family Practice; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009887:Ophthalmoscopy; D010781:Photography; D011446:Prospective Studies; D012017:Referral and Consultation; D012160:Retina; D012423:Rural Health; D012680:Sensitivity and Specificity; D006113:United Kingdom; D014504:Urban Health