title: Availability of color fundus photographs from previous visit affects practice patterns for patients with diabetes mellitus.
abstract: OBJECTIVE
  To determine whether access to color fundus photographs from a patient's previous visit would alter the recommendations rendered to a cohort with diabetic retinopathy.
  
  
  METHODS
  One hundred sixty patients with diabetic retinopathy returning for a follow-up visit and who had color fundus photographs obtained at a previous visit were evaluated by trained retina specialists. Their clinical impression and recommendations regarding management of diabetic retinopathy were recorded without reference to previous photographs. Color fundus photographs from the patient's most recent visit were then reviewed and new recommendations with regard to appropriate treatment and follow-up were recorded.
  
  
  RESULTS
  In 21% of cases, after reviewing the patient's most recent color fundus photographs, the clinical recommendation changed. In 14% of cases, photographs clearly demonstrated that the patient's condition was stable or improved, resulting in a change from recommending treatment to recommending deferral of treatment. In 4% of cases, photographs clearly demonstrated clinical worsening and the recommendation was changed from observation to treatment. In 3% of cases, review of photographs prompted a change in the recommended follow-up interval.
  
  
  CONCLUSIONS
  Access to color fundus photographs from a patient's previous visit frequently changed the clinical recommendations made to patients with diabetic retinopathy regarding appropriate treatment and follow-up. Availability of color fundus photographs therefore has implications about quality of care and may affect the cost of care.
authors.affiliation: Retinal Vascular Center, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Md., USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Rosberger
authors.forename: A P
authors.initials: AP
authors.lastname: Schachat
authors.forename: S B
authors.initials: SB
authors.lastname: Bressler
authors.forename: N M
authors.initials: NM
authors.lastname: Bressler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010781:Photography; D010818:Practice Patterns, Physicians'; D012160:Retina / Q000473:pathology*