title: Ophthalmic nurse practitioner led diabetic retinopathy screening. Results of a 3-month trial.
abstract: OBJECTIVE
  To describe the design and implementation of a nurse led diabetic retinopathy screening clinic. To present the results of a 3-month trial period assessing the concordance of retinopathy grading between a nurse practitioner and an ophthalmologist.
  
  
  METHODS
  Patients attending for annual diabetic eye review during an initial 3-month trial period were assessed in a dedicated diabetic eye clinic by an ophthalmic nurse practitioner and an ophthalmologist, with both grading the degree of diabetic retinopathy using to the Wisconsin grading system. Each was masked as to the other's findings. The concordance of retinopathy grading between ophthalmic nurse practitioner and ophthalmologist was assessed.
  
  
  RESULTS
  A total of 95 patients (189 eyes) were assessed during the study period. A 92% concordance was achieved between the ophthalmologist and the ophthalmic nurse practitioner. In total, 72 eyes were graded as having some degree of retinopathy by the ophthalmologist. The sensitivity of the nurse practitioner for diagnosing the presence of diabetic retinopathy was 93%, and the specificity 91%. Nine eyes with severe nonproliferative diabetic retinopathy or worse, and four with clinically significant macular oedema were seen. All were correctly identified by the nurse practitioner.
  
  
  CONCLUSIONS
  The structure and management protocols of the clinic are described. An excellent concordance between ophthalmologist and nurse practitioner was achieved in this group of patients with relatively less advanced retinopathy.
authors.affiliation: Flinders Medical Centre, Adelaide, Australia. brad_kirkwood70@hotmail.com
authors.forename: B J
authors.initials: BJ
authors.lastname: Kirkwood
authors.forename: D J
authors.initials: DJ
authors.lastname: Coster
authors.forename: R W
authors.initials: RW
authors.lastname: Essex
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000451:nursing; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000451:nursing* / Q000458:organization & administration; D008875:Middle Aged; D009722:Nurse Practitioners / Q000592:standards*; D015588:Observer Variation; D011446:Prospective Studies; D012720:Severity of Illness Index; D013021:South Australia; D015351:Vision Screening / Q000379:methods / Q000451:nursing / Q000458:organization & administration