The Article in Brief

Accuracy of Primary Care Clinicians in Screening for Diabetic Retinopathy Using Single-Image Retinal Photography

Tillman F. Farley , and colleagues

Background Early detection and treatment of diabetic retinopathy, an eye disease common in people with diabetes, can slow or prevent the development of blindness. Screening for diabetic retinopathy usually involves an ophthalmologist (eye specialist), but low-income patients may have limited access to such specialists. Researchers have tested a screening program in which primary care doctors are trained to read a single image taken with a retinal camera, a tool that can identify diabetic retinopathy. This study looks at the doctors' accuracy in reading the photographic images and correctly identifying patients needing referral to ophthalmologists.

What This Study Found Primary care doctors trained to read single images from a retinal camera have acceptable accuracy in screening for diabetic retinopathy. They screened 1,040 diabetic patients at a low-income health center. One hundred thirteen (10.9%) were found to have diabetic retinopathy, 46 severe enough to need referral to an ophthalmologist. Participating doctors missed diabetic retinopathy in 8.7% of the patients who had it (4 out of 46), but discovered it in 41 others. Of the 344 patients the ophthalmologist believed needed referral, primary care doctors failed to refer 35 (10.2%), usually because the doctor failed to recognize an inadequate photograph or abnormalities other than diabetic retinopathy.

Implications

• Using single-image retinal photography in primary care offices, with primary care doctors reading the images, may be a cost-effective way to help reduce vision loss in diabetes patients who have limited access to ophthalmologists.
• Further training may be needed to help primary care doctors recognize other common eye problems.