title: Accuracy of screening for diabetic retinopathy by family physicians.
abstract: BACKGROUND
  We wanted to examine the accuracy of family physicians' screening for diabetic retinopathy using standardized criteria and a nonmydriatic ophthalmoscope.
  
  
  METHODS
  Eleven family physicians assessed 28 standardized patients with diabetes mellitus using the PanOptic ophthalmoscope. Their assessments of whether the patients required referral to an ophthalmologist were compared with the reference standard of retinal diagrams.
  
  
  RESULTS
  The mean sensitivity for the family physicians was 87% (95% confidence interval [CI], 83%-91%) with a specificity of 57% (95% CI, 46%-68%). Overall agreement was moderate, with a mean kappa = .43 (95% CI, 0.39%-0.47%).
  
  
  CONCLUSIONS
  Using standardized criteria and a nonmydriatic ophthalmoscope, family physicians were fairly accurate in screening patients for diabetic retinopathy. Whereas this technique is not sufficiently accurate to replace routine referral for all patients with diabetes, it can be used to improve care for those patients who fail to get routine eye screenings.
authors.affiliation: Christiana Care Health Services, 1401 Foulk Rd, Wilmington, DE 19803, USA. jgill@christianacare.org
authors.forename: James M
authors.initials: JM
authors.lastname: Gill
authors.forename: David M
authors.initials: DM
authors.lastname: Cole
authors.forename: Harry M
authors.initials: HM
authors.lastname: Lebowitz
authors.forename: James J
authors.initials: JJ
authors.lastname: Diamond
mesh_terms: D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005194:Family Practice; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009885:Ophthalmology; D019721:Ophthalmoscopes; D009887:Ophthalmoscopy / Q000592:standards*; D015203:Reproducibility of Results