title: Diagnostic performance of retinal digital photography for diabetic retinopathy screening in primary care.
abstract: We must study alternatives to structure an effective diabetic retinopathy screening program for Brazilian public health system.
  
  
  
  Evaluate the diagnostic performance of retinal digital photography for diabetic retinopathy screening in primary care, accuracy of the family physician in diabetic retinopathy identification compared to the ophthalmologist, and the need for dilation.
  
  
  
  In a primary care service were performed retinal photographs with non-mydriatic Retinal Camera in 219 type 2 diabetic patients with and without medication mydriasis. We evaluated the performance of the diagnostic of the photos graded by three family physicians with training compared to two ophthalmologists (gold standard), and explore related factors with the need for mydriasis pharmacologically.
  
  
  
  The prevalence of diabetic retinopathy and proliferative diabetic retinopathy was 19.2% and 1.5%, respectively. The sensitivity of family physicians to evaluate diabetic retinopathy averaged 82.9% (66.7-94.8%); specificity, 92% (90.2-93.3%); the accuracy, 90.3% (88.2-93%) and positive predictive value, 71.2% (68-75.5%). The agreement calculated using the kappa adjusted coefficient was from 0.74 to 0.8 for retinopathy and 0.88 to 0.92 for macular edema. Without drug mydriasis the photos were unreadable by 14.8%, when using mydriatic collyrium this number decreased to 8.7% (McNemar test, P < 0.005). Patients with more than 65 years old has more readability after drug mydriasis (McNemar test, P = 0.011).
  
  
  
  Trained family physician reached a good performance for evaluation of retinography for diabetic retinopathy. There was improvement in readability with pupil dilation in older patients.
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Ana P O
authors.initials: APO
authors.lastname: Rosses
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Telessaúde, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Collective Health Department, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil.
authors.forename: Ângela J
authors.initials: ÂJ
authors.lastname: Ben
authors.affiliation: Telessaúde, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Primary care service, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Camila Furtado de
authors.initials: CF
authors.lastname: Souza
authors.affiliation: Ophthalmology Service, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Skortika
authors.affiliation: Telessaúde, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Aline Lutz de
authors.initials: AL
authors.lastname: Araújo
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Gabriela de
authors.initials: G
authors.lastname: Carvalho
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Franciele
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Primary care service, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Neumann
mesh_terms: D001938:Brazil; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D000072163:Ophthalmologists / Q000592:standards / Q000706:statistics & numerical data; D010781:Photography; D010821:Physicians, Family / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care
chemical_list: D009184:Mydriatics
keywords: Diabetes / insulin resistance; family health; ophthalmology / visual impairment; prevention; screening