title: Screening for diabetic retinopathy by non-ophthalmologists: an effective public health tool.
abstract: OBJECTIVE
  To investigate and report the reliability of detection and grading of diabetic retinopathy by direct ophthalmoscopy through a dilated pupil by general physicians (non-ophthalmologists) and optometrists who have undergone a short period of training.
  
  
  METHODS
  A total of 400 eyes of 200 diabetes patients were examined by two non-ophthalmologists. Their observations were compared with an ophthalmologist's diagnoses for the same patients.
  
  
  RESULTS
  The diagnoses made by the general physician (kappa = 0.8381, SE = 0.041) and the optometrist (kappa = 0.7186, SE = 0.051) showed good rates of agreement with the ophthalmologist's diagnoses.
  
  
  CONCLUSIONS
  The provision of appropriate screening protocols and follow-up parameters can enable primary care physicians and support personnel to reliably screen individuals for retinopathy in diabetes. This will reduce the workload of tertiary hospitals, and provide optimal services to the huge majority of the Indian population that has limited access to eye care services.
authors.affiliation: Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110 029, India.
authors.forename: Lalit
authors.initials: L
authors.lastname: Verma
authors.forename: Gunjan
authors.initials: G
authors.lastname: Prakash
authors.forename: Hem K
authors.initials: HK
authors.lastname: Tewari
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Gupta
authors.forename: G V S
authors.initials: GV
authors.lastname: Murthy
authors.forename: Nisha
authors.initials: N
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D009907:Optometry / Q000592:standards*; D015980:Public Health Practice / Q000592:standards*; D015203:Reproducibility of Results; D019987:Persons with Visual Disabilities