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E DiFranco, M Tolentino, M Brightwell-Arnold, L Riva-Clement, A Shih, M Maguire; Screening for Diabetic Retinopathy in a Dialysis Clinic Setting using a Non-Mydriatic Retinal Camera . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3471.
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Purpose:1) To examine the willingness to participate in a program to facilitate receipt of dilated eye examinations and to have fundus photographs taken at no cost on site among diabetic patients attending a dialysis clinic; 2) to estimate the percentage of such patients with signs indicating the need for treatment. Methods: Diabetic patients in three area dialysis clinics were offered enrollment in a community outreach program ("4Sight Program") that facilitates dilated eye examinations, and the opportunity to have fundus photographs taken on site. Patients received advance notice about the program. Trained laypersons conducted patient interviews, collected demographic data and consent, and performed the photography. Photographs were taken with a Canon CR6-45NM Non-Mydriatic Retinal Camera after dilation of pupils. A retinal specialist graded photos for signs of diabetic retinopathy and clinically significant macular edema. Patients with signs of treatable disease or who were overdue for an eye examination received letters advising that they schedule an examination with assistance of the 4Sight Program. Results: 121 patients were approached in the dialysis clinics, of these, 11 (9%) were already 4Sight members, and 52 (43%) agreed to join. The predominant reason for refusing enrollment was patient's self-reported compliancy with eye exams and/or non-interest. 41 (65%) of the 63 4Sight patients consented to photography and 29 (46%) were photographed. 15 patients had BDR, 2 patients had PDR, and 7 patients had some signs of clinically significant macular edema. 5 patients already had PRP, and 5 patients had had focal laser. Three patients were referred based on photographic findings of possible treatable disease (who were not currently being treated); and additional 9 were referred because of overdue examinations. Conclusion: Despite considerable efforts to provide screening for diabetic retinopathy at no cost to the patient, only 52% of patients enrolled in the program and only 24% of the 121 patients had photography. Targeting dialysis clinics for on site photographic reading may not be cost effective since considerable effort must be expended to identify a few patients with disease that may be treatable.
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