title: Managing 'suspicious glaucomatous discs' identified during digital-photography-based diabetic retinopathy screening.
abstract: OBJECTIVE
  An audit to demonstrate the outcome of patients identified with suspicious glaucomatous discs within a digital-photography-based diabetic retinopathy screening programme.
  
  
  METHODS
  Primary care based digital photographic screening was performed utilising mydriasis and two-field digital photography for all patients with diabetes. Patients identified with discs suspicious of glaucomatous optic neuropathy (GON) were initially referred to an accredited community-based optometrist for further assessment. Some patients were then referred to secondary care where appropriate.
  
  
  RESULTS
  From 1st April 2002 to 31st March 2003 a total of 3868 patients were screened for diabetic retinopathy. This audit revealed that 55 subjects were identified by retinal screeners as having discs suspicious of glaucoma. A total of 29 were already under glaucoma clinic review. A total of 23/26 remaining were referred for an assessment by an accredited optometrist. Of these 13 were normal, 6 were referred to secondary care and 4 failed to attend. The three remaining were referred directly to secondary care.
  
  
  CONCLUSIONS
  All nine referrals to secondary care were deemed appropriate by a glaucoma specialist. This suggests that the system described does not lead to over-referral of suspicious discs - although the issue of how many glaucomatous discs are missed during screening (false negatives) will only be answered in the longer term.
authors.affiliation: Sunderland Eye Infirmary, UK. chris.steele@chs.northly.nhs.uk
authors.forename: C
authors.initials: C
authors.lastname: Steele
authors.forename: D
authors.initials: D
authors.lastname: Steel
authors.forename: H
authors.initials: H
authors.lastname: Bone
authors.forename: L
authors.initials: L
authors.lastname: McParland
authors.forename: L
authors.initials: L
authors.lastname: Green
authors.forename: S
authors.initials: S
authors.lastname: Fraser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000473:pathology; D003941:Diagnostic Techniques, Ophthalmological; D005901:Glaucoma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008485:Medical Audit / Q000379:methods; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000473:pathology; D010781:Photography / Q000379:methods; D012017:Referral and Consultation