title: Screening for diabetic retinopathy: the first telemedical approach in a primary care setting in France.
abstract: OBJECTIVE
  Diabetic retinopathy (DR) remains a major cause of visual impairment in France, due to insufficient regular annual screening. Fundus photography is a sensitive alternative to ophthalmoscopy for DR screening. The aim of our study was to report the first telemedical approach to this screening in a primary care setting in France.
  
  
  METHODS
  A DR screening centre equipped with a nonmydriatic camera was opened in the 18th district of northern Paris and placed at the disposal of general practitioners (GPs) of the Réseau de Santé Paris Nord (North Paris Health Network). These GPs were invited to send their diabetic patients who had no known DR and had had no fundus examination for more than one year to this screening center. Retinal photographs were taken by an orthoptist without pupillary dilation and sent for grading through the Internet to the Lariboisière Hopital Ophthalmology Department.
  
  
  RESULTS
  During an 18-month period, 912 DR screening examinations were performed in 868 diabetic patients referred to the DR screening center by 240 GPs. Patients' mean +/- SD age was 59.9 +/- 11.1 years. Of these 868 patients, 260 (30%) said they never have had an ophthalmological examination. Diabetic retinopathy was detected in 197 patients (22.7%). The proportion of patients for whom fundus photographs of one or both eyes could not be assessed was 10.1%. 159 patients (18.3%) required referral to an ophthalmologist.
  
  
  CONCLUSIONS
  Nonmydriatic photography, combined with teletransmission to a reading centre, proved to be a feasible valid method for the detection of DR. This screening method allowed the identification of patients requiring prompt referral to an ophthalmologist for further complete eye examination.
authors.affiliation: Département d'ophtalmologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. p.massin@lrb.ap-hop-paris.fr
authors.forename: P
authors.initials: P
authors.lastname: Massin
authors.forename: J-P
authors.initials: JP
authors.lastname: Aubert
authors.forename: A
authors.initials: A
authors.lastname: Erginay
authors.forename: J C
authors.initials: JC
authors.lastname: Bourovitch
authors.forename: A
authors.initials: A
authors.lastname: Benmehidi
authors.forename: G
authors.initials: G
authors.lastname: Audran
authors.forename: B
authors.initials: B
authors.lastname: Bernit
authors.forename: M
authors.initials: M
authors.lastname: Jamet
authors.forename: C
authors.initials: C
authors.lastname: Collet
authors.forename: M
authors.initials: M
authors.lastname: Laloi-Michelin
authors.forename: P J
authors.initials: PJ
authors.lastname: Guillausseau
authors.forename: A
authors.initials: A
authors.lastname: Gaudric
authors.forename: M
authors.initials: M
authors.lastname: Marre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D010781:Photography; D010821:Physicians, Family; D017216:Telemedicine / Q000379:methods*