Diagnosing Diabetic Retinopathy by General Practitioners and by a Hospital Physician: The use of fundus photos

Abstract

Five non-ophthalmologists (four general practitioners and a hospital physician) assessed the retinal status of 62 patients with diabetes mellitus, using fundus photos. They had no particular interest in diabetic retinopathy, nor did they receive special training. Their diagnoses were compared with the diagnostic opinion of two ophthalmologists, whose diagnoses served as the standard.

The use of reference charts (photos of normal retinas and retinas with diabetic retinopathy) reduced the number of false negative assessments. The sensitivity of the non-ophthalmologists varied between 100 per cent and 88 per cent, depending on the standard (diagnosis of one ophthalmologist or consensus between two ophthalmologists). The specificity was 55 percent, indicating the potentially high rate of inappropriate referral.

The coefficient of agreement of diagnosis between the non-ophthalmologists and the ophthalmologists was kappa 0.54. All but one patient put on treatment by the ophthalmologists had been identified by the non-ophthalmologists. The possibility of fundus photography in patient managenent (consultation on photo reading instead of a referral of the patient) is discussed.

It is concluded that the assessment of fundus photos to detect diabetic retinopathy by general physicians seems to be a promising strategy in the surveillance of patients with diabetes mellitus.

Key Words:

• diabetes mellitus
• fundus photos
• diagnosis
• non-ophthalmologists