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R Zeimer, I Zimmer-Galler, T Meeder; Screening for Diabetic Retinopathy in the Primary Care Physician's Office: Pilot Implementation of the DigiScope . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3859.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Treatment of diabetic retinopathy can reduce the risk of severe visual loss, but its success depends on timely detection of retinopathy. Unfortunately, on average, half of diabetic patients do not visit an ophthalmologist annually as recommended. In order to increase the number of diabetic patients being screened for retinopathy, we developed the DigiScope, an instrument specifically designed to operate in the offices of primary care physicians (PCP). The DigiScope acquires images of the posterior pole and assesses visual acuity under the operation of PCP staff. The data are automatically transferred, via the Internet, to a reading center where trained readers, under the supervision of retina specialists, determine if the patient needs to be referred to an ophthalmologist for diagnosis and care. A previous independent validation study [The DigiScope Compared With 7-Field Photography For The Detection of Diabetic Retinopathy. R.M. Schiffman et.al. ARVO 2001 (Nr: 3968)] showed a sensitivity of 0.99 and a specificity of 0.96, thereby justifying a pilot implementation. Method: DigiScopes were placed in offices of PCP members of Health Alliance Plan (Detroit, Michigan). The screened population consisted of 227 diabetic patients who visited their PCP for reasons not related to vision. The patients' pupils were dilated and the office staff operated the DigiScope. The patients were referred to an ophthalmologist if their early retinopathy exceeded stage 2A on the ETDRS scale. The patients filled out a questionnaire after the exam. Results: Of the 33 (15%) referrals, 3 (1.3%) were considered urgent and 9 (4%) were due to ungradeable images. 41% of the patients stated that they had not seen an ophthalmologist in the previous 3 years. 100% of the patients responded that they would be willing to repeat the procedure the following year. Conclusion: The results indicate that screening for retinopathy in the PCP environment with the DigiScope is efficient, practical and identifies retinopathy in patients who otherwise do not obtain timely ophthalmic care. Implementation of this screening method should allow referral of more diabetic patients requiring care to ophthalmologists thereby reducing the risk of vision loss.
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