title: Comparison of a digital retinal imaging system and seven-field stereo color fundus photography to detect diabetic retinopathy in the primary care environment.
abstract: OBJECTIVE
  Because patients with diabetes mellitus may visit their primary care physician regularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologist was evaluated.
  
  
  METHODS
  In a masked prospective study, images were obtained from 11 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared.
  
  
  RESULTS
  Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on "no retinopathy" versus "any retinopathy" was excellent (Kappa = 0.96). Agreement based on "microaneurysms or less retinopathy" versus "retinal hemorrhages or worse retinopathy" was very good (Kappa = 0.83).
  
  
  CONCLUSIONS
  The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.
authors.affiliation: Eye Care Services, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Rhett M
authors.initials: RM
authors.lastname: Schiffman
authors.forename: Gordon
authors.initials: G
authors.lastname: Jacobsen
authors.forename: Julian J
authors.initials: JJ
authors.lastname: Nussbaum
authors.forename: Uday R
authors.initials: UR
authors.lastname: Desai
authors.forename: J David
authors.initials: JD
authors.lastname: Carey
authors.forename: David
authors.initials: D
authors.lastname: Glasser
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Zimmer-Galler
authors.forename: Ran
authors.initials: R
authors.lastname: Zeimer
authors.forename: Morton F
authors.initials: MF
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003116:Color; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods*; D011320:Primary Health Care; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D012680:Sensitivity and Specificity; D014792:Visual Acuity