title: Diabetic retinopathy screening using tele-ophthalmology in a primary care setting.
abstract: We evaluated tele-ophthalmology for diabetic retinopathy screening in a primary care setting. Four general practitioners (GPs) were taught to assess non-mydriatic retinography images of patients with diabetes. After training, a total of 1223 patients were screened using this method: 926 (76%) did not have diabetic retinopathy and 297 (24%) were referred for an ophthalmologic assessment. Of the 297 patients, 186 (15%) did not have diabetic retinopathy and were considered to be false positives, 85 (7%) had diabetic retinopathy and in 26 cases (2%) the retinography images were unreadable. The specificity of GPs for detecting diabetic retinopathy by non-mydriatic retinography was 83%. Ophthalmologists also assessed 120 patients who had been diagnosed as normal to detect false negatives. Ten patients (8.3%) had mild non-proliferative diabetic retinopathy with small isolated retinal hemorrhages. Only one patient (0.8%) had treatable diabetic retinopathy with hard exudates and microaneurysms. The sensitivity of GPs for detecting diabetic retinopathy was 90.9%; the sensitivity for detecting treatable lesions was 99.2%. We concluded that adequately trained GPs can screen for treatable lesions of diabetic retinopathy with a very high level of reliability using non-mydriatic retinography.
authors.affiliation: Department of Ophthalmology, Hospital de Navarra, 31007 Pamplona, Spain. jandonen@cfnavarra.es
authors.forename: José
authors.initials: J
authors.lastname: Andonegui
authors.forename: Luis
authors.initials: L
authors.lastname: Serrano
authors.forename: Aitor
authors.initials: A
authors.lastname: Eguzkiza
authors.forename: Lara
authors.initials: L
authors.lastname: Berástegui
authors.forename: Laura
authors.initials: L
authors.lastname: Jiménez-Lasanta
authors.forename: Daniel
authors.initials: D
authors.lastname: Aliseda
authors.forename: Idoia
authors.initials: I
authors.lastname: Gaminde
mesh_terms: D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003951:Diagnostic Errors; D003941:Diagnostic Techniques, Ophthalmological; D058006:General Practice / Q000193:education; D006801:Humans; D008403:Mass Screening / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000458:organization & administration*