Objective: To assess the accuracy of grading diabetic retinopathy (DR) using single-field digital fundus photography compared with clinical grading from a dilated slit-lamp fundus examination in Indigenous Australians living in Central Australia.
Design, setting and participants: Cross-sectional study comparing DR grades in participants with diabetes mellitus presenting for examination at remote community clinics from 1 July 2005 to 30 June 2008.
Results: Of the 1884 participants recruited for the study, 1040 had self-reported diabetes mellitus and, of those, 360 had fundus photographs available (706 eyes) that were able to be graded. On clinical grading, 163 eyes had any DR and 51 eyes had vision-threatening DR (VTDR). The sensitivity and specificity for detecting any DR were 74% (95% CI, 67%–80%) and 92% (95% CI, 90%–94%), respectively. The sensitivity and specificity for detecting VTDR were 86% (95% CI, 77%–96%) and 95% (95% CI, 93%–97%), respectively.
Conclusion: Single-field digital fundus photography is a valid screening tool for DR in remote communities of central Australia and may be used to provide eye care services to this region with acceptable accuracy.
- 1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 837-853.
- 2. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology 1998; 105: 1801-1815.
- 3. Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004; 82: 844-851.
- 4. Tapp RJ, Shaw JE, Harper CA, et al; AusDiab Study Group. The Prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 2003; 26: 1731-1737.
- 5. Xie J, Arnold AL, Keeffe J, et al. Prevalence of self-reported diabetes and diabetic retinopathy in Indigenous Australians: the National Indigenous Eye Health Survey. Clin Experiment Ophthalmol 2011; 39: 487-493.
- 6. Landers J, Henderson T, Abhary S, Craig J. Prevalence and associations of diabetic retinopathy in Indigenous Australians within central Australia: the Central Australian Ocular Health Study. Clin Experiment Ophthalmol 2010; 38: 393-397.
- 7. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol 1985; 103: 1796-1806.
- 8. Schoenfeld ER, Greene JM, Wu SY, Leske MC. Patterns of adherence to diabetes vision care guidelines: baseline findings from the Diabetic Retinopathy Awareness Program. Ophthalmology 2001; 108: 563-571.
- 9. Lee PP, Feldman ZW, Ostermann J, et al. Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. Ophthalmology 2003; 110: 1952-1959.
- 10. Bragge P, Gruen RL, Chau M, et al. Screening for presence or absence of diabetic retinopathy: a meta-analysis. Arch Ophthalmol 2011; 129: 435-444.
- 11. Landers J, Henderson T, Craig J. Central Australian Ocular Health Study: design and baseline description of participants. Clin Experiment Ophthalmol 2010; 38: 375-380.
- 12. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991; 98 (5 Suppl): 786-806.
- 13. Williams GA, Scott IU, Haller JA, et al. Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology. Ophthalmology 2004; 111: 1055-1062.
- 14. Joannou J, Kalk WJ, Mahomed I, et al. Screening for diabetic retinopathy in South Africa with 60 degrees retinal colour photography. J Intern Med 1996; 239: 43-47.
- 15. Maberley D, Cruess AF, Barile G, Slakter J. Digital photographic screening for diabetic retinopathy in the James Bay Cree. Ophthalmic Epidemiol 2002; 9: 169-178.
- 16. Herbert HM, Jordan K, Flanagan DW. Is screening with digital imaging using one retinal view adequate? Eye (Lond) 2003; 17: 497-500.
- 17. Taylor DJ, Fisher J, Jacob J, Tooke JE. The use of digital cameras in a mobile retinal screening environment. Diabet Med 1999; 16: 680-686.
- 18. Pugh JA, Jacobson JM, Van Heuven WA, et al. Screening for diabetic retinopathy. The wide-angle retinal camera. Diabetes Care 1993; 16: 889-895.
- 19. Lin DY, Blumenkranz MS, Brothers RJ, Grosvenor DM. The sensitivity and specificity of single-field nonmydriatic monochromatic digital fundus photography with remote image interpretation for diabetic retinopathy screening: a comparison with ophthalmoscopy and standardized mydriatic color photography. Am J Ophthalmol 2002; 134: 204-213.
- 20. National Health and Medical Research Council. Guidelines for the management of diabetic retinopathy. Canberra: Commonwealth of Australia, 2008. http://www.nhmrc.gov.au/guidelines/publications/di15 (accessed Jul 2012).
- 21. Hutchinson A, McIntosh A, Peters J, et al. Effectiveness of screening and monitoring tests for diabetic retinopathy--a systematic review. Diabet Med 2000; 17: 495-506.
- 22. Lawrence MG. The accuracy of digital-video retinal imaging to screen for diabetic retinopathy: an analysis of two digital-video retinal imaging systems using standard stereoscopic seven-field photography and dilated clinical examination as reference standards. Trans Am Ophthalmol Soc 2004; 102: 321-340.
- 23. Landers J, Henderson T, Craig J. Prevalence and associations of cataract in Indigenous Australians within central Australia: the Central Australian Ocular Health Study. Clin Experiment Ophthalmol 2010; 38: 387-392.
- 24. Diamond JP, McKinnon M, Barry C, et al. Non-mydriatic fundus photography: a viable alternative to fundoscopy for identification of diabetic retinopathy in an Aboriginal population in rural Western Australia? Aust N Z J Ophthalmol 1998; 26: 109-115.
- 25. Harper CA, Livingston PM, Wood C, et al. Screening for diabetic retinopathy using a non-mydriatic retinal camera in rural Victoria. Aust N Z J Ophthalmol 1998; 26: 117-121.
- 26. Lee SJ, McCarty CA, Taylor HR, Keeffe JE. Costs of mobile screening for diabetic retinopathy: a practical framework for rural populations. Aust J Rural Health 2001; 9: 186-192.
- 27. Maberley D, Walker H, Koushik A, Cruess A. Screening for diabetic retinopathy in James Bay, Ontario: a cost-effectiveness analysis. CMAJ 2003; 168: 160-164.
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