Evaluation of a screening program for diabetic retinopathy in a primary care setting Dodia (Dépistage ophtalmologique du diabète) study.
OBJECTIVE
The aim of this observational study was to evaluate the screening for diabetic retinopathy (DR) using eye fundus photography taken by a nonmydriatic camera and transmitted trough the Internet to an ophthalmological reading centre, as compared to a dilated eye examination performed by an ophthalmologist.


METHODS
A total of 456 and 426 diabetic patients were included by two different groups of primary care physicians (PCPs), 358 being screened with the non-mydriatic camera (experimental group) and 320 with dilated eye fundus exam (control group).


RESULTS
The proportion of screened patients for whom PCPs received a screening report within the 6-month follow-up period was 74,1% for the experimental group and 71,5% for the control group. Screening for DR was negative in 77,6% of patients with eye fundus photographs vs 89,6% with dilated eye examination. DR was diagnosed in 62 patients (17,3%) with eye fundus photographs versus 31 with dilated eye examination (10,4%). Referral to an ophthalmologist was required in 59 reports of patients with photographs (16.5%), 23 of them due to high grade DR. Finally, the non-mydriatic camera was found of little inconvenience by patients.


CONCLUSIONS
The telemedical approach to DR screening proved to be effective in providing primary care practitioners with information about their patient's eye status. This screening method allowed to identify patients requiring prompt referral to the ophthalmologist for further complete eye examination. In conclusion, this study provided successful results of DR screening using fundus photography in primary care patients, and strongly supports the need to further extend this screening program in a larger number of French sites.
Massin
P
P
Ophthalmology Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris Cedex 10, France. p.massin@lrb.aphp.fr
Aubert
J P
JP
Eschwege
E
E
Erginay
A
A
Bourovitch
J C
JC
BenMehidi
A
A
Nougarède
M
M
Bouée
S
S
Fagnani
F
F
Tcherny
M S
MS
Jamet
M
M
Bouhassira
M
M
Marre
M
M
D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000517:prevention & control*; D005451:Fluorescein Angiography / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010821:Physicians, Family; D011331:Private Practice; D015203:Reproducibility of Results; D016896:Treatment Outcome