Evaluation of diabetic retinopathy screening using fundus photography: Evaluation and epidemiologic factors at Nantes university medical center

Introduction.-The goal of our study was to evaluate the results of screening for diabetic retinopathy using the non-mydriatic fundus camera combined with telemedicine in the university hospital of Nantes. Patients and Methods.-This is a retrospective study of all diabetic patients hospitalized in the endocrinology department between June and September 2016 inclusive. The photos were taken by a nurse if the patient had an indication for screening as determined by the attending physician. The ophthalmologist then provided a written interpretation of the photos on a consultant's sheet. Quality control with re-reading of a sample of the photos was performed. Results.-A total of 442 patients (48% females, 52% males) were studied. 227 patients (51.3%) had undergone an eye examination within the previous year. 160 patients (36.2%) were screened with fundus photography. Fundus photography of at least one eye could not be graded in 10 patients (6.3%). Diabetic retinopathy was detected in 27 patients (16.9%) and diabetic maculopathy in 5 patients. Longer duration of diabetes and the presence of microalbuminuria were significantly associated with incidence of retinopathy. The double reading of 26% of the photos found a 93% of concordance between the 2 readers. Referral to an ophthalmologist was required in 32 patients (20%), of whom 27 were rescheduled at the university hospital, for unreadable photographs, diabetic retinopathy or concomitant eye disease. 38.5% of rescheduled patients did not come to the appointment. Conclusion.-Non-mydriatic fundus photography combined with telemedicine is attractive for diabetic retinopathy screening and identifies patients requiring further eye examination. In our study, it obviated the need for an ophthalmologic examination in 8 out of 10 cases. It is important to continue to educate patients about the necessity of regular eye examinations and post-screening follow-up. (C) 2019 Elsevier Masson SAS. All rights reserved.