title: Telemedical diabetic retinopathy screening in Hungary: a pilot programme.
abstract: Our aim was to introduce the Hungarian pilot telemedical screening program for diabetic retinopathy (DRP) and also to evaluate the efficacy of non-mydriatic fundus photographs. A total of 502 eyes of 251 diabetic patients were photographed with a non-mydriatic digital fundus camera in a tertiary diabetology care center. These three 45°-field images were transmitted to the reading center via Internet, where they were graded by two independent ophthalmologists. After non-mydriatic photography (NM method), 28 patients were also examined in mydriasis by an ophthalmologist (O method) and were also photographed in mydriasis (M method). For the comparison of the three methods the kappa statistic was used. With non-mydriatic imaging of 502 eyes no retinopathy was found in 74.5%, DRP was detected in 15.5%, while 10.1% of the photos were ungradable. The rates of DRP severity levels were: 13.55% mild/moderate non-proliferative, 0.59% severe and 1.39% proliferative DRP. Comparing the results of the gradable non-mydriatic photos by the two independent graders, perfect intergrader agreement was found (k = 1.00). The measure of intermethod agreement between NM and M method was also perfect, with a kappa value of 1.00 (grader A and grader B). Based on the results of the O method, there were no misdiagnosed cases nor with the NM-, neither with the M method. Non-mydriatic cameras could be ideal tools of an extended countrywide retinopathy screening program which may serve to reduce the high prevalence of diabetes-related blindness in Hungary.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Dorottya
authors.initials: D
authors.lastname: Szabó
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Fiedler
authors.affiliation: 2 Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Anikó
authors.initials: A
authors.lastname: Somogyi
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Gábor Márk
authors.initials: GM
authors.lastname: Somfai
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Bíró
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Veronika
authors.initials: V
authors.lastname: Ölvedy
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Zsófia
authors.initials: Z
authors.lastname: Hargitai
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary nemeth.janos@med.semmelweis-univ.hu.
authors.forename: János
authors.initials: J
authors.lastname: Németh
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D006814:Hungary; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010781:Photography / Q000379:methods*; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods*; D013686:Telemetry