Screening for diabetic retinopathy using a three-field digital nonmydriatic fundus camera in the North of France

Purpose. - To evaluate screening for diabetic retinopathy, using three-field nonmydriatic fundus photography, combined with telemedicine, in two hospitals. Methods. - Patients from the Endocrinology Department of Saint Philibert Hospital were screened consecutively from March 2007 to September 2008. Three 450 digital images per eye examination were taken using a nonmydriatic fundus camera and sent by intranet to the Department of Ophthalmology of Saint Vincent de Paul Hospital for grading by two ophthalmologists. Results. - A total of 1147 patients (52% mates, 48% females) were screened. The mean age was 60 years (range, 19-92 years). Most patients had type 2 diabetes (n = 1000; 90%). The mean HbA1c was 8%. Microalbuminuria was detected in 239 patients (20.8%). Of these 1147 patients, 521 (45%) said they had never had a fundus examination before. Fundus photography of at least one eye could not be graded in 160 patients (14%). Diabetic retinopathy was detected in 187 patients (19%). Suspected macular edema (hard exudates within one disc diameter of the macular center) was found in 38 patients (3.8%). Referral to an ophthalmologist was required in 347 patients (30%) for diabetic retinopathy and unreadable photographs. During the period of the study, 107 patients had both three-field nonmydriatic photography and dilated funduscopy, which was used as reference. Agreement between the two readers was 0.97. Conclusions. - Nonmydriatic photography combined with telemedicine is useful for screening for diabetic retinopathy and identifies patients requiring further complete eye examination. Good collaboration between the two centers is required to improve the follow-up after screening in the future. (C) 2009 Elsevier Masson SAS. All rights reserved.