title: Screening for diabetic retinopathy by ophthalmologists and endocrinologists with pupillary dilation and a nonmydriatic digital camera.
abstract: OBJECTIVE
  To assess the effects of pupillary dilation on image quality and certitude of screening diabetic retinopathy by trained endocrinologists using a digital nonmydriatic camera.
  
  
  METHODS
  Prospective, comparative, observational case series.
  
  
  METHODS
  One hundred fifty patients with diabetes attending a hospital-based photographic screening clinic had five-field (45 degree) digital retinal imaging and mosaic construction, first through dark-adapted pupils, then after a single application of tropicamide 1%. The 600 sets of images (150 patients, 300 eyes, before and after dilation) were graded independently and in a blinded manner by two endocrinologists and two ophthalmologists, with the consensual opinion on dilated images of the latter serving as the gold standard. The criteria of evaluation were assessment of image quality and certitude of detecting and grading retinopathy.
  
  
  RESULTS
  Of 300 eyes, pharmacological mydriasis improved image quality, with an increase in the number of eyes with five good images from seven to 160 and good-quality mosaics from 99 to 233. Dilation allowed better identification of maculopathy in the second eye because there was a decrease in ungradeable central images from 127 to 15 eyes. Dilation increased the number of eyes having retinopathy detected with certainty from 153 to 252 and graded with certainty from 173 to 277. No adverse effects were recorded.
  
  
  CONCLUSIONS
  Single application of tropicamide 1% significantly improves image quality and certitude of screening diabetic retinopathy with nonmydriatic camera by endocrinologists.
authors.affiliation: Department of Ophthalmology, Bellevue Hospital, Saint-Etienne, France.
authors.forename: Nilanjana
authors.initials: N
authors.lastname: Deb-Joardar
authors.forename: Natacha
authors.initials: N
authors.lastname: Germain
authors.forename: Gilles
authors.initials: G
authors.lastname: Thuret
authors.forename: Pierre
authors.initials: P
authors.lastname: Manoli
authors.forename: Anne-Frederique
authors.initials: AF
authors.lastname: Garcin
authors.forename: Luc
authors.initials: L
authors.lastname: Millot
authors.forename: Yann
authors.initials: Y
authors.lastname: Gavet
authors.forename: Bruno
authors.initials: B
authors.lastname: Estour
authors.forename: Phillipe
authors.initials: P
authors.lastname: Gain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003623:Dark Adaptation; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D004704:Endocrinology / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D009885:Ophthalmology / Q000379:methods*; D010781:Photography / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects*; D014331:Tropicamide / Q000008:administration & dosage
chemical_list: D009184:Mydriatics; D014331:Tropicamide