Comparison of Screening Fundus Photography and Dilated Fundus Examination in an Underserved Clinic Population of Diabetics

Abstract

Abstract: : Purpose: To ascertain the prevalence of retinal abnormalities, including, but not limited to diabetic retinopathy, in an inner city diabetic population, using a comparison of nonmydriatic photos with dilated fundus exam. Methods: A prospective study was instituted comparing dilated fundus examination with photos taken using a Kowa α–D nonmydriatic fundus camera in an inner city hospital diabetic retinopathy screening clinic. The same physician performed both the fundus examination and the photographic reading, but was masked as to the patient’s identity when reading the photos. Diagnosis and follow up were determined for each patient using both methods, and then correlated. Incidence of retinal abnormalities other than diabetic retinopathy was also determined using both methods. Results: A total of 194 eyes in 98 patients were included. Using nonmydriatic photographs, 47.4% of eyes screened were found to have no BDR, 5.7% of eyes were found to have NPDR/no CSME, 4.6% of eyes were found to have CSME, and 1.0% of eyes were found to have PDR. Using dilated fundus examinations, 54.7% of eyes screened were found to have no BDR, 12.0% were found to have NPDR/no CSME, 3.6% were found to have CSME, and 1.5% had PDR. In addition, 36.1% of eyes screened using nonmydriatic photography were found to have other retinal pathology, as opposed to 28.0% of eyes using dilated fundus exams. However,19.4% of the photos were unreadable. Finally, there was 100% correlation with respect to disposition and follow up between both methods. Conclusions: We found extremely high correlation using these two different methods of screening for diabetic retinopathy . Although there was not 100% correlation in the number of eyes found to have NPDR, CSME, or PDR, this did not ultimately effect management decisions. Of note, a higher yield of other significant retinal pathology was found using photography (36.1%) versus dilated fundus examinations (28.0%). These results suggest that in inner city diabetics, the prevalence of coexisting retinal pathology is high and can be detected with equal reliability using either nonmydriatic photography or dilated fundus examinations.

Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical (human) or epidemiologic studies: health care delivery/economics/manpower