Outreach screening for diabetic retinopathy holds potential
MedWire News: Outreach screening for diabetic retinopathy may be an effective alternative to on-site specialist examination, especially in remote and resource poor areas, show results from a meta-analysis of relevant studies.
Hugh Taylor (University of Melbourne, Victoria, Australia) and colleagues selected 20 studies for the analysis. The mean cohort size per study was 207, but ranged from 14 to 773 patients. The participants were aged 58 years on average.
To be included, studies had to assess the accuracy of a diabetic retinopathy screening method in patients with diabetes or diabetic retinopathy and compare photography- or examination-based retinopathy screening (outreach screening) with 7-field mydriatic photography and dilated fundal examination by a medical specialist (on-site examination).
In the outreach model, a photographer, technician or health worker took nondilated retinal pictures, which were then assessed at a later date by an ophthalmologist or medical specialist.
As reported in the Archives of Ophthalmology, dilation status (mydriatic versus non mydriatic pictures) did not significantly affect the sensitivity or specificity of retinopathy detection.
Variation in the medical qualifications of the outreach photographers did not significantly influence sensitivity, but did affect specificity of retinopathy detection. Specificity of detection was 3.86-fold higher when photographers had specialist medical or eye qualifications.
"The outreach model has enormous potential to increase the screening coverage of at-risk populations in areas of the world where specialist ophthalmic resources are limited and to be a cost-effective way of preventing blindness among diabetics," say Taylor et al.
They caution: "Our analysis was confined to the presence or absence of diabetic retinopathy. Future studies should use consistent diabetic retinopathy classification schemes to facilitate further analysis."
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By Helen Albert