Abstract
Abstract: :
Purpose: Screening of diabetic retinopathy (DR) by non mydriatic digital camera (i.e. without pharmacological mydriasis) is spreading in France. We designed a clinical research project, which aims to compare, within an endocrinology ward, the efficiency of the screening by ophthalmologists and by endocrinologists. Since the beginning of this project, we realised that the lack of pupillary dilatation was detrimental to its feasibility. i/ the lack for a dedicated dark room in the endocrinology ward, the need for patients to stay during 10 to 20 minutes in the dark were not compatible with the medical check up done during their short stay in hospital. ii/ the quality of screening itself seemed affected. Aim of this study: to compare the feasibility and the quality of DR screening in patients without (ND) and then with dilation (D) Methods: One hundred and fifty consecutively hospitalized diabetic patients had 5 fundus photographs of each eye (TRC NRW6S, TOPCON), taken by an experienced observer, firstly without and then with dilatation with 1 drop of 1% tropicamide. The 600 sets of retinographies were analysed blind to the dilatation status: time of image capture, number of missing quadrant, quality of each pictures (Good/ Bad) and of the mosaic (good G, average A/ bad B/ not gradable NG), certainty of the screening, of the grading of DR, and in the diagnosis of maculopathy (certain C/ doubtful D/ impossible I). Four observers: 2 ophthalmologists and 2 endocrinologists after proper training Results: Group D : gain in time (3 min per eye) thanks to a better quality of each image (G 3,5±1,8 vs 0,8±1,1 p<0,001) and of the mosaic (G 73 vs 40%, A 18 vs 28%, B 7 vs 20%, NG 1 vs 13%, p=0.001), lesser number of ungradable screening (generally due to a cataract, 1% vs 13%, p=0.001) or doubtful images (17% vs 35% p=0.001) Conclusions: Pharmacological pupillary dilatation improves both feasibility and efficiency of RD screening by digital camera in our institution and in the conditions of our clinical research project. Considering the advantages (time saving, no disturbance of endocrinological check up during hospitalization, better DR screening) and the good acceptability by nurses and patients (only one drop of tropicamide, no prolonged stay in the dark), we decided to generalize the pupillary dilatation for all diabetic patients enrolled in our clinical research project.
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical research methodology