title: Non-mydriatic single-field fundus photography for the screening of retinal diseases in an executive health clinic.
abstract: OBJECTIVE
  To determine the accuracy and sensitivity of a single-field non-mydriatic digital fundus image interpreted by an ophthalmologist and performed within a primary care setting.
  
  
  METHODS
  Fundus photography using a digital non-mydriatic camera was performed on both eyes of 1,175 consecutive patients as part of an executive health program. All fundus images included a 45° field of the posterior pole capturing the optic nerve and macular area. Diagnostic findings were recorded and appropriate recommendations for follow-up were made. Patients were then contacted to see whether appropriate follow-up was successfully completed and chart reviews were performed to determine biomicroscopic findings.
  
  
  RESULTS
  Photographs were adequate in both eyes in 1,117 patients (95.1%). Examination findings were normal in both eyes in 951 (85.1%) patients. Abnormal findings were noted in either eye in 166 (14.9%) patients. The most common abnormal findings were macular degeneration (57/166, 34.3%), optic nerve cupping (45/166, 27.1%), hypertensive retinopathy (15/166, 9.0%), and choroidal nevi (10/166, 6.0%). In all patients with abnormal findings, routine follow-up ophthalmologic examination with an eye care specialist was indicated and none of the patients required urgent attention. Sensitivity was found to be 87% and stratification was performed based on the initial diagnosis. False-positive results were from confounding diagnoses rather than true false-positives.
  
  
  CONCLUSIONS
  Single-field non-mydriatic fundus photography is accurate and sensitive for screening retinal disease in a primary care setting.
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Ahmad B
authors.initials: AB
authors.lastname: Tarabishy
authors.forename: John P
authors.initials: JP
authors.lastname: Campbell
authors.forename: Anita
authors.initials: A
authors.lastname: Misra-Hebert
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Seballos
authors.forename: Richard S
authors.initials: RS
authors.lastname: Lang
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
mesh_terms: D000554:Ambulatory Care Facilities; D003936:Diagnosis, Computer-Assisted; D003941:Diagnostic Techniques, Ophthalmological; D005240:Feasibility Studies; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009184:Mydriatics; D010781:Photography; D011320:Primary Health Care / Q000379:methods; D012164:Retinal Diseases / Q000473:pathology*; D012680:Sensitivity and Specificity
chemical_list: D009184:Mydriatics