No loss of chance of diabetic retinopathy screening by endocrinologists with a digital fundus camera.
OBJECTIVE
To compare the efficacy of the diabetic retinopathy (DR) screening with digital camera by endocrinologists with that by specialist and resident ophthalmologists in terms of sensitivity, specificity, and level of "loss of chance."


METHODS
In a cross-sectional study, 500 adult diabetic patients (1,000 eyes) underwent three-field retinal photography with a digital fundus camera following pupillary dilatation. Five endocrinologists and two ophthalmology residents underwent 40 h of training on screening and grading of DR and detection of associated retinal findings. A κ test compared the accuracy of endocrinologist and ophthalmology resident screening with that performed by experienced ophthalmologists. Screening efficiency of endocrinologists was evaluated in terms of "loss of chance," i.e., missed diagnoses that required ophthalmologist referrals.


RESULTS
The mean weighted κ of DR screening performed by endocronologists was similar to that of ophthalmology residents (0.65 vs. 0.73). Out of 456 DR eyes, both endocrinologists and ophthalmology residents misdiagnosed only stage 1 DR (36 and 14, respectively), which did not require ophthalmologist referral. There were no significant differences between endocrinologists and ophthalmology residents in terms of diabetic maculopathy and incidental findings except for papillary cupping and choroidal lesions, which were not the main purpose of the study or of the training.


CONCLUSIONS
The endocrinologist with specific training for DR detection using a three-field digital fundus camera with pupillary dilatation can perform a reliable DR screening without any loss of chance for the patients when compared with identical evaluation performed by experienced ophthalmologists.
Department of Endocrinology, Diabetes and Metabolism, University Hospital, Saint-Etienne, France.
Natacha
N
Germain
Bodgan
B
Galusca
Nilanjana
N
Deb-Joardar
Luc
L
Millot
Pierre
P
Manoli
Gilles
G
Thuret
Philippe
P
Gain
Bruno
B
Estour
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D004704:Endocrinology / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000295:instrumentation*; D010781:Photography / Q000379:methods*; D012680:Sensitivity and Specificity; D055815:Young Adult
JAMA. 2007 Aug 22;298(8):902-16
17712074
Diabetes Metab. 2008 Jun;34(3):227-34
18468470
Lancet. 1996 Dec 14;348(9042):1604
8961988
Med Econ. 2009 May 8;86(9):32
19526904
Optom Vis Sci. 2006 Sep;83(9):625-36
16971837
J Fr Ophtalmol. 1997;20(4):302-10
9181143
Diabet Med. 2003 Aug;20(8):635-41
12873290
Diabetes Care. 2005 Sep;28(9):2334-5
16123521
Diabetes Care. 2000 Mar;23(3):345-8
10868863
Diabetes Care. 2010 Jan;33 Suppl 1:S11-61
20042772
Biometrics. 1977 Mar;33(1):159-74
843571
Diabetes Care. 2008 Nov;31(11):2131-5
18728235
Diabet Med. 1998 Feb;15(2):170-5
9507921
Diabetes Metab. 2000 Dec;26(6):497-9
11173722
Telemed J E Health. 2004 Winter;10(4):469-82
15689653
Am J Ophthalmol. 2005 Nov;140(5):814-821
16310458
Diabet Med. 2007 Mar;24(3):303-7
17263768
Diabetes Care. 2008 Feb;31(2):193-8
18024852
Ann Fam Med. 2008 Sep-Oct;6(5):428-34
18779547
Diabetes Res Clin Pract. 2010 Jan;87(1):4-14
19896746
S Afr Med J. 2005 Jan;95(1):57-61
15762251
Eye (Lond). 2007 Apr;21(4):487-93
16456597
Diabetes Metab. 2004 Apr;30(2):140-5
15223985
Am J Ophthalmol. 2009 Jul;148(1):111-8
19406376