title: Non-mydriatic fundus photography: a viable alternative to fundoscopy for identification of diabetic retinopathy in an Aboriginal population in rural Western Australia?
abstract: OBJECTIVE
  To evaluate the Canon CR5-45NM non-mydriatic fundus camera (Canon, Kanagawa, Japan) for identifying retinopathy and the need for laser treatment in a population of Aboriginal patients with diabetes mellitus in rural Western Australia.
  
  
  METHODS
  Diabetic Aboriginal patients were photographed through undilated pupils using a Canon CR5-45NM non-mydriatic fundus camera, after which ophthalmoscopy was performed using indirect ophthalmoscopy through dilated pupils. The examining ophthalmologist recorded the presence of retinopathy and the need for laser treatment. A proportion of patients were rephotographed through dilated pupils. Photographs were reviewed by a second ophthalmologist who evaluated the quality of the image, the presence of retinopathy and the need for laser treatment. Results of fundus photographs and ophthalmoscopy were compared.
  
  
  RESULTS
  Three hundred and twenty-eight eyes in 164 Aboriginal patients were examined. The mean patient age was 48.2 years (range 16-81 years) and the mean duration of diabetes was 7.5 years (range 1-35 years). Seventy-four eyes (22.6%) were diagnosed with retinopathy using combined examination techniques, 44 (59.5%) of which were identified by ophthalmoscopy and 55 (74.3%) by photography. Thirty-five eyes were deemed to need treatment, 18 (51.4%) of which were identified by ophthalmoscopy and 30 (85.7%) by photography. Kappa coefficient measurement for agreement for presence of retinopathy and need for referral was 0.41 and 0.53, respectively. Photograph quality was significantly improved following pupil dilation.
  
  
  CONCLUSIONS
  The Canon CR5-45NM non-mydriatic fundus camera was relatively good at identifying diabetic retinopathy and could usefully be applied within a screening programme for treatable disease within this population.
authors.affiliation: Department of Ophthalmology, Royal Perth Hospital, Western Australia, Australia.
authors.forename: J P
authors.initials: JP
authors.lastname: Diamond
authors.forename: M
authors.initials: M
authors.lastname: McKinnon
authors.forename: C
authors.initials: C
authors.lastname: Barry
authors.forename: D
authors.initials: D
authors.lastname: Geary
authors.forename: I L
authors.initials: IL
authors.lastname: McAllister
authors.forename: P
authors.initials: P
authors.lastname: House
authors.forename: I J
authors.initials: IJ
authors.lastname: Constable
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology / Q000601:surgery; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D009887:Ophthalmoscopy / Q000379:methods; D010781:Photography / Q000379:methods*; D012160:Retina / Q000473:pathology*; D012424:Rural Population; D014904:Western Australia / Q000453:epidemiology
chemical_list: D009184:Mydriatics