Nonmydriatic digital retinal images for determining diabetic retinopathy.

OBJECTIVE: To evaluate the efficacy of nonmydriatic digital retinal images for determining diabetic retinopathy. MATERIAL AND METHOD: Single field 45-degree digital retinal images of 225 eyes from 142 diabetic patients were obtained with a nonmydriatic camera. The images were diagnosed and graded by a general ophthalmologist. These results were compared with clinical diagnosis obtained by retinal specialists, after examination by using biomicroscope with plus lens and indirect ophthalmoscope of the patients. International clinical diabetic retinopathy disease severity scale was used for grading diabetic retinopathy in all cases. RESULTS: Presence of diabetic retinopathy was detected in 70 eyes (31.1%). The sensitivity and specificity for determining diabetic retinopathy was 68.57% (95%CI 57.00-78.20) and 92.25% (95%CI 87.00-95.50), respectively. The positive predictive value and negative predictive value was 80.00% (95%CI 68.20-88.20) and 86.67% (95%CI 80.60-91.00). Overall accuracy was 84.89%. CONCLUSION: Single field 45-degree nonmydriatic digital retinal images were limited by fair sensitivity for determining diabetic retinopathy although overall accuracy from the present study was relatively high. Upcountry, this tool might facilitate increased access of diabetic patients for eye evaluation but cannot replace standard eye examination.

Delivery of photocoagulation treatment for diabetic retinopathy at a large Australian ophthalmic hospital: comparisons with national clinical practice guidelines.

OBJECTIVE: To determine if the delivery of photocoagulation for diabetic retinopathy at a large Australian ophthalmic hospital conforms with Australian National Health and Medical Research Council clinical practice guidelines. METHODS: A retrospective medical record review was conducted of all patients who had initial laser treatment for diabetic retinopathy at the Royal Victorian Eye and Ear Hospital from January 1997 to December 1998. RESULTS: The study included 322 eyes from 203 patients. The mean age was 65.8 years (range 18-89 years) and the mean duration of diabetes was 14.7 years (range 1-40 years). Panretinal photocoagulation (PRP) alone was performed in 37 eyes over a mean number of 2.6 sessions. The median waiting time for these procedures was 14 days (range 0-146 days) and the median follow-up time was 7.1 weeks (range 1-25 weeks). Focal treatment was performed (without PRP) in 238 eyes and 55.5% of these cases required repeat focal treatment for persistent clinically significant macular oedema. Median waiting time for focal treatment was 20 days (range 0-302 days) and the median follow-up time after treatment was 12.1 weeks (range 1.7-42.0 weeks). Focal and PRP treatment was used in 47 eyes that had maculopathy concurrently with proliferative retinopathy. Focal treatment was applied before (or at the same session as) the PRP wherever possible. CONCLUSIONS: The study indicates that the application of photocoagulation and follow up for diabetic retinopathy at this tertiary referral institution conforms closely with Australian clinical practice guidelines.

Clinical outcomes following laser photocoagulation treatment for diabetic retinopathy at a large Australian ophthalmic hospital.

OBJECTIVE: To evaluate clinical outcomes of diabetic retinopathy laser treatment at a large Australian ophthalmic hospital. METHODS: A retrospective medical record review of all patients who had initial laser treatment for diabetic retinopathy at the Royal Victorian Eye and Ear Hospital from January 1997 to December 1998. RESULTS: The study included 322 eyes from 203 patients. The mean age was 65.8 years (range 18-89) and the mean follow up was 18 months (range 2-33). Focal photocoagulation treatment alone was performed in 238 eyes. Clinically significant macular oedema (CSME) resolved in 218 (91.6%) eyes. Vision was improved or maintained in 137 (57.6%) eyes. Moderate visual loss occurred in 49 (20.6%) eyes. Panretinal photocoagulation (PRP) was performed in 84 eyes, including 37 eyes with PRP alone and 47 eyes with PRP and focal together. Neovascularization regressed in 55 (65.5%) eyes. Vision was improved or maintained in 52 (61.9%) eyes. Moderate visual loss was observed in 20 (23.8%) eyes and severe visual loss was observed in 4 (4.8%) eyes. CONCLUSIONS: The clinical outcomes reported here are similar to those reported in other studies.

Nonmydriatic digital retinal images for determining diabetic retinopathy.

OBJECTIVE: To evaluate the efficacy of nonmydriatic digital retinal images for determining diabetic retinopathy. MATERIAL AND METHOD: Single field 45-degree digital retinal images of 225 eyes from 142 diabetic patients were obtained with a nonmydriatic camera. The images were diagnosed and graded by a general ophthalmologist. These results were compared with clinical diagnosis obtained by retinal specialists, after examination by using biomicroscope with plus lens and indirect ophthalmoscope of the patients. International clinical diabetic retinopathy disease severity scale was used for grading diabetic retinopathy in all cases. RESULTS: Presence of diabetic retinopathy was detected in 70 eyes (31.1%). The sensitivity and specificity for determining diabetic retinopathy was 68.57% (95%CI 57.00-78.20) and 92.25% (95%CI 87.00-95.50), respectively. The positive predictive value and negative predictive value was 80.00% (95%CI 68.20-88.20) and 86.67% (95%CI 80.60-91.00). Overall accuracy was 84.89%. CONCLUSION: Single field 45-degree nonmydriatic digital retinal images were limited by fair sensitivity for determining diabetic retinopathy although overall accuracy from the present study was relatively high. Upcountry, this tool might facilitate increased access of diabetic patients for eye evaluation but cannot replace standard eye examination.