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B. Barahimi, U.S. Rao, C. Recchia, L.M. Merin, K. Guentri, A. Chomsky, F. Recchia; Analysis Of Ophthalmic Pathology Other Than Diabetic Retinopathy Diagnosed By Photographic Screening Of Diabetic Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3868.
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Telemedicine is routinely used to assess the extent and progression of retinal pathology in diabetic patients. The purpose of this study was to determine if these fundoscopic screening methods could also be a valuable tool for identifying non diabetic ocular pathology.
Consecutive reports of all diabetic patients enrolled in a photographic screening program for diabetic retinopathy at the Tennessee Valley Veterans Administration Healthcare System between June 2003 and March 2005 were reviewed. The reports were based on the analyses of 2 sets of monoscopic, 45–degree photographs, centered on the macula and optic nerve. The records were reviewed for presence of any ocular pathology unrelated to diabetes and their life/sight threatening urgency.
This study included 4942 diabetic patients, of which 1557 (32%) were referred to seek care for non diabetic ocular diseases. A total of 105 (2%) patients were referred to see an ophthalmologist or a primary care physician urgently within two weeks from the screening date. Among the reasons for the urgent referrals were optic nerve swelling (n=24, 23%), exudative age related macular degeneration (n=12, 11%), retinal vein occlusion (n=11, 10%), and thromboembolic disease (n=11, 10%). Non urgent referrals (seen within three months) occurred in 1452 patients (29%). The most common reasons for non urgent referrals included unexplained visual acuity ≤20/50 in either eye (n=626, 43%), cup–to–disc ratio ≥0.6 in either eye leading to suspicion of glaucoma (n=541, 37%) and vitreomacular traction (n=77, 5%). All 40 patients (0.8%) in whom grading was precluded due to poor image quality were also referred for non urgent evaluation
Fundus photographic screening of diabetic patients identifies findings suggestive of vision–threatening and life–threatening conditions in a significant number of patients. Fundoscopic screening of diabetics results in referrals for diseases other than diabetic retinopathy and may be a beneficial screening tool for a range of ophthalmic and systemic diseases.
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