Abstract
BackgroundDiabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries. Diabetic retinopathy screening is effective in preventing blindness and can be performed through various diagnostic methods. Our objective is to compare binocular indirect ophthalmoscopy (BIO) to telemedicine protocols of digital retinography for diabetic retinopathy screening in a large and heterogenous type 1 diabetes population in a developing country.MethodsData from 1266 Type 1 Diabetes Mellitus patients from a Brazilian multicenter study were analyzed. Patients underwent BIO and digital retinography, non-mydriatic and mydriatic. Images were sent to a reading center in a telemedicine protocol. Agreement between the different methods was calculated with kappa statistic for diabetic retinopathy and maculopathy classification. Clinical outcome was either observation or referral to specialist.ResultsAgreement between BIO and mydriatic retinography was substantial (kappa 0.67–0.74) for diabetic retinopathy observation vs referral classification. Agreement was fair to moderate (kappa 0.24–0.45) between retinography and BIO for maculopathy. Poor mydriasis was the main obstacle to image reading and classification, especially on the non-mydriatic strategy, occurring in 11.9 % of right eyes and 16.9 % of left eyes.ConclusionMydriatic retinography showed a substantial agreement to BIO for diabetic retinopathy observation vs referral classification. A significant amount of information was lost on the non-mydriatic technique because of poor mydriasis. We recommend a telemedicine-based diabetic retinopathy screening strategy with digital mydriatic retinography, preferably with 2 fields, and advise against non-mydriatic retinography in developing countries.
Highlights
Diabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries
Written informed consent was obtained from all patients, and the local ethics committee approved the study protocol. Each patient had both eyes examined, whenever possible, and underwent non-mydriatic retinography (NMR), mydriatic 2 field retinography and mydriatic binocular indirect ophthalmoscopy (BIO)
After BIO, each eye was classified for diabetic retinopathy and maculopathy according to the American Academy of Ophthalmology guidelines [10] (Tables 1, 2)
Summary
Diabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries. Our objective is to compare binocular indirect ophthalmoscopy (BIO) to telemedicine protocols of digital retinography for diabetic retinopathy screening in a large and heterogenous type 1 diabetes population in a developing country. Diabetic retinopathy (DR) is one of the main causes of preventable blindness in the world, affecting 12.6 million and threatening the vision of 37.3 million in 2010 [1]. It is DR screening has been considered to have an excellent cost-effectiveness [3, 4], allowing the detection of early. There are currently no nationwide studies of DR prevalence in Brazil, but available data point to a prevalence ranging from 7.62 to 44.4 % of patients with diabetes, representing 0.9–5.3 million people [13,14,15,16,17,18,19]
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