title: Screening for sight threatening diabetic retinopathy using non-mydriatic retinal camera in a primary care setting: to dilate or not to dilate?
abstract: OBJECTIVE
  To evaluate three different strategies (without or with mydriasis) for community based screening for sight threatening diabetic retinopathy (STDR).
  
  
  METHODS
  A masked cross-sectional comparative study.
  
  
  METHODS
  Primary care centre.
  
  
  METHODS
  216 type-1 and type-2 diabetic patients (432 eyes).
  
  
  METHODS
  Screening for STDR was performed with the Topcon CRW6S non-mydriatic camera (NMC), compared with the grading of the seven-field standard stereoscopic photographs, 30 degrees field photographs with mydriasis as the gold standard method. Three fields were studied: Field 1 centred on the macula; field 2 centred on the disc and the macula and field 3 centred on the disc, on the macula and temporal upper to the macula all without and with mydriasis.
  
  
  METHODS
  Sensitivity and specificity of screening method and prevalence of STDR. Strategies: field 1 (macular), addition of field 2 (nasal), addition of field 3 (superior temporal) all without and with mydriasis.
  
  
  RESULTS
  The prevalence of STDR was 14.3%. When screening without mydriasis is performed, the percentage of referred patients increases from 14% (STDR) to almost 33% because of ungradable photographs. Sensitivity of detection of STDR by NMC using single field with mydriasis was 82% (95% confidence interval 72-92%) and without mydriasis 67% (54-80%). Specificity was 99% (97-100%) for single field with mydriasis and 99% (98-100%) without mydriasis. Sensitivity of detection using two fields with mydriasis was 95% (89-100%); without mydriasis (54-80%), slightly better than single field with mydriasis (72-92%). Specificity was similar.
  
  
  CONCLUSIONS
  Screening for STDR with NMC can be performed effectively with one non-stereoscopic retinal photograph per eye with mydriasis using tropicamide 0.5%. Screening without mydriasis increases the number of patients to be referred.
authors.affiliation: Clinical Medicine Department, Hospital Universitario Elche, University Miguel Hernandez, Alicante, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Baeza
authors.forename: D
authors.initials: D
authors.lastname: Orozco-Beltrán
authors.forename: V F
authors.initials: VF
authors.lastname: Gil-Guillen
authors.forename: V
authors.initials: V
authors.lastname: Pedrera
authors.forename: M C
authors.initials: MC
authors.lastname: Ribera
authors.forename: S
authors.initials: S
authors.lastname: Pertusa
authors.forename: J
authors.initials: J
authors.lastname: Merino
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage*; D010781:Photography / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014331:Tropicamide / Q000008:administration & dosage*
chemical_list: D009184:Mydriatics; D014331:Tropicamide