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Diabetic retinopathy screening in general practice: a pilot study.

BACKGROUND
Early detection and treatment of diabetic retinopathy (DR) can prevent nearly all associated severe vision loss. We investigated the feasibility of DR screening using nonmydriatic cameras in two Australian primary care clinics.


METHODS
Two general practitioners from Queensland photographed the retinas of patients with type 2 diabetes seen in their clinics during the 9 month study period. The patients were then photographed and assessed by two independent ophthalmologists. The ophthalmologists' assessments provided the reference standard. General practitioners' accuracy in determining photograph interpretability and DR diagnostic sensitivity and specificity were measured. The attitudes of GPs about the DR screening were also assessed.


RESULTS
One hundred and fourteen patient participants provided 219 photographs. Two ophthalmologists read 158 photographs and deemed 61% (97/158) interpretable, but GPs tended to accept more photographs for interpretation. General practitioners' diagnostic sensitivity and specificity was 87% and 95% respectively. Participating GPs were very positive about expanding their clinical role into DR screening.


DISCUSSION
General practice based DR screening was feasible and acceptable in the clinics studied, but photograph quality was an issue.