Diabetic retinopathy screening by endocrinologist using digital fundus camera is safe, secure
Endocrinologists who are specially trained to detect diabetic retinopathy using a digital fundus camera can screen for diabetic retinopathy without loss of chance for the patients when compared with evaluations performed by ophthalmologists.
Researchers at Saint-Etienne University Hospital in France conducted a cross-sectional study that included 500 adult patients with diabetes. All of the patients underwent three-field retinal photography with a digital fundus camera after pupillary dilatations. Five endocrinologists and two ophthalmology residents underwent 40 hours of training focused on the photographic detection and gradation of diabetic retinopathy.
The efficiency of endocrinologists screening was measured by loss of chance, which is missed diagnoses requiring an ophthalmologist referral. Two retina specialists evaluated the same images, and their consensus opinion was considered the gold standard. Accuracy was demonstrated by agreement between the observer and the gold standard, using a keratometry test. Each eye had three images taken.
Of 962 analyzable eyes, the endocrinologists and ophthalmology residents detected diabetic retinopathy in 456 eyes. Of these, the endocrinologists misdiagnosed only 36 eyes with stage I diabetic retinopathy, which did not require a referral to an ophthalmologist. There was no loss of chance for the 120 eyes diagnosed with more than stage I diabetic retinopathy that were referred to ophthalmologists.
These results enable the delegation of diabetic retinopathy screening to the endocrinologists using a digital camera, the researchers wrote. At a national health care framework level, delegation of diabetic retinopathy screening to endocrinologists with no loss of chance could potentially increase the proportion of patients with diabetes who undergo this important preventive intervention.
For more information:
- Germain N. Diabetes Care. 2011;doi:10.2337/dc10-1373.
Disclosure: The researchers report no relevant financial disclosures.