title: Screening for diabetic retinopathy using a digital non-mydriatic camera compared with standard 35-mm stereo colour transparencies.
abstract: OBJECTIVE
  To investigate the use of a digital non-mydriatic camera for determining the ETDRS clinical level of diabetic retinopathy, and to evaluate its use in a screening setting to appropriately determine the need for referral to an ophthalmologist (ETDRS level > or = 35).
  
  
  METHODS
  A total of 83 patients with diabetes were photographed with and without pharmacological pupil dilation at an ophthalmology department using a digital non-mydriatic camera, obtaining two sets of five non-stereoscopic, 45 degree field images of each eye. ETDRS seven standard field, 35-mm stereoscopic colour fundus photographs were also obtained. A subgroup of 59 patients was photographed at an optician's shop using the digital non-mydriatic camera without pupil dilation.
  
  
  RESULTS
  There was substantial agreement between the clinical level of diabetic retinopathy assessed from the 35-mm photographs and the digital images: the ophthalmology department (kappa = 0.76) with pupil dilation and (kappa = 0.66) without pupil dilation, respectively, and at the optician's (kappa = 0.60 without pupil dilation). With respect to the need for referral to an ophthalmologist, there was almost perfect agreement in the ophthalmology department (kappa = 0.88) with pupil dilation and (kappa = 0.84) without pupil dilation, respectively, and those taken at the optician's (kappa = 0.87 without pupil dilation).
  
  
  CONCLUSIONS
  A digital non-mydriatic camera may be used in a screening situation to appropriately determine the need for referral to an ophthalmologist (ETDRS level > or = 35).
authors.affiliation: Department of Ophthalmology, Herlev Hospital, University of Copenhagen, Herlev, Denmark. anbha@herlevhosp.kbhamt.dk
authors.forename: Anja B
authors.initials: AB
authors.lastname: Hansen
authors.forename: Birgit
authors.initials: B
authors.lastname: Sander
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Kleener
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Henrik
authors.initials: H
authors.lastname: Lund-Andersen
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D010781:Photography / Q000379:methods*; D011680:Pupil / Q000187:drug effects; D012017:Referral and Consultation; D015203:Reproducibility of Results
chemical_list: D009184:Mydriatics