title: Early detection of diabetic retinopathy by a mobile retinal photography service working in partnership with primary health care teams.
abstract: Community-wide fundus photography was organized for early detection of diabetic retinopathy (DR) by mobile teams. High-quality three-field Kodachrome fundus photography, performed according to the London Protocol through dilated pupils was offered free of charge to primary care; images were taken in the community and assessed centrally. Data are presented from the first 80 primary health care centres (PHCCs) participating, serving 990,000 (about 60%) of inhabitants in Stockholm County. Beginning in 1990, 6863 diabetes patients were invited by PHCCs; 5490 (80%) attended. We reached 77% of persons with known diabetes; only 37% had had their eyes examined during the preceding 2 years. For 97% of patients, images were assessable. DR was present in 34% of patients (non-proliferative DR not requiring further assessment 29%, non-proliferative DR requiring further assessment 1.1%, proliferative DR 0.5% and macular involvement 3.6%). Re-examination after 2 years was offered to 64%; follow-up photography after 1 year to 24%. Fluorescein angiography and/or photocoagulation treatment was performed in 3.6%. This method of early diagnosis is feasible, acceptable, and reached twice as many patients as did the usual referral-based system of care. We now plan to extend this service to cover the whole county.
authors.affiliation: Department of Ophthalmology, Karolinska Institute, St Erik's Eye Hospital, Stockholm, Sweden. lars.backlund@ood.ki.se
authors.forename: L B
authors.initials: LB
authors.lastname: Bäcklund
authors.forename: P V
authors.initials: PV
authors.lastname: Algvere
authors.forename: U
authors.initials: U
authors.lastname: Rosenqvist
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D008952:Mobile Health Units; D010781:Photography; D011320:Primary Health Care