Primary care clinicians had acceptable accuracy in screening for diabetic retinopathy

Study results indicated that primary care clinicians accurately screened for diabetic retinopathy after being trained to read single-image retinal photographs from a retinal camera.

From 2001 to 2004, researchers at various institutions in Colorado analyzed agreement between readings of retinal photographs by primary care clinicians and readings of the same images by an ophthalmologist.

Among the 1,040 patients with diabetes screened, primary care clinicians determined 113 (10.9%) had diabetic retinopathy; 46 patients were determined to be severe cases who needed referral to an ophthalmologist.

However, the clinicians failed to refer 35 (10.2%) of the 344 patients that the ophthalmologist determined needed referral. Most missed cases were due to failure to recognize an inadequate photograph or abnormalities other than diabetic retinopathy, according to the researchers.

In a smaller final analysis of 344 patients referred to an ophthalmologist, primary care clinicians missed diabetic retinopathy in 8.7% of patients (four of 46), yet discovered retinopathy in 41 other patients.

Screening for diabetic retinopathy at the primary care level may save money and reduce vision loss for uninsured or low-income patients with diabetes who have limited access to an ophthalmologist, according to the researchers.

Ann Fam Med. 2008;6:428-434.