Screening for diabetic retinopathy in primary care with a mobile fundal camera--evaluation of a South African pilot project.
OBJECTIVE
In South Africa diabetes makes a significant contribution to the burden of disease. Diabetic retinopathy is a leading cause of adult blindness, and screening can reduce the incidence. This project aimed to implement and evaluate a new service for retinal screening that uses a non-mydriatic mobile fundal camera in primary care. This is the first time such a service has been evaluated in an African primary care context.


METHODS
The service was implemented as an operational research study at three community health centres and data were collected to evaluate the operational issues, screening, reporting and referral of patients.


RESULTS
Out of 400 patients screened 84% had a significantly reduced visual acuity, 63% had retinopathy (22% severe nonproliferative, 6% proliferative and 15% maculopathy), 2% of eyes could not be screened and 14% of patients required dilatation. Referral was necessary in 27% of cases for cataracts, in 7% for laser treatment and in 4% for other specialist services. Repeat photography was needed in 8% and urgent follow-up in 12%. A SWOT analysis of the pilot project was completed and recommendations were made on how to integrate it into the district health system.


CONCLUSIONS
Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician should be able to photograph almost 10,000 patients a year.
Mash
Bob
B
Division of Family Medicine and Primary Care, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, W Cape. rm@sun.ac.za
Powell
Di
D
du Plessis
Felicity
F
van Vuuren
Unita
U
Michalowska
Margaret
M
Levitt
Naomi
N
D000328:Adult; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D008875:Middle Aged; D010781:Photography / Q000295:instrumentation*; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods*; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D013019:South Africa / Q000453:epidemiology