Comparison between binocular indirect ophthalmoscopy and digital retinography for diabetic retinopathy screening: the multicenter Brazilian Type 1 Diabetes Study

Diabetology & Metabolic Syndrome

Sergio Atala Dib¹  Marília Brito Gomes⁵  Franz Schubert Lopes Leal⁸  Ricardo Vessoni Perez⁹  Felipe Mallmann²  André Araújo Pinheiro³  Tessa Cerqueira Lemos Mattos^1,10  Karla Rezende Guerra Drummond⁶  Michel Eid Farah⁷  Paulo Henrique Morales⁷  Fernando Korn Malerbi⁴ 

[1] Department of Endocrinology, Federal University of São Paulo, São Paulo, Brazil;Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil;Department of Ophthalmology, Hospital Regional de Taguatinga, Brasília, Brazil;Departments of Endocrinology and Ophthalmology, Federal University of São Paulo, São Paulo, Brazil;Department of Endocrinology, State University of Rio de Janeiro, Rio de Janeiro, Brazil;Department of Ophthalmology, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil;Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil;Department of Ophthalmology, University of Campinas, Campinas, Brazil;Department of Endocrinology, University of São Paulo, São Paulo, Brazil;Department of Ophthalmology, Centro de Endocrinologia e Diabetes do Estado da Bahia, Salvador, Brazil

关键词: Blindness;    Retinography;    Screening;    Telemedicine;    Diabetic retinopathy;   

Others  :  1235147
DOI  :  10.1186/s13098-015-0110-8

 received in 2015-09-18, accepted in 2015-12-01,  发布年份 2015

【 摘 要 】

Background

Diabetic 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.

Methods

Data 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.

Results

Agreement 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.

Conclusion

Mydriatic 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.

【 授权许可】

   
2015 Malerbi et al.

【 图 表 】

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