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- W966168316 abstract "Editor—We have concerns about the National Screening Committee's recommendations for a risk reduction programme for diabetic retinopathy, in which digital photography is the screening method of choice.1 The gold standard for fundus examination is slit lamp biomicroscopy performed by an experienced ophthalmologist; this is the standard on which treatment decisions are made. The same technique used by other trained professionals in a screening environment duplicates the gold standard.Slit lamp biomicroscopy has advantages over fundus photography. It offers a stereoscopic view, thereby detecting diffuse macular oedema that is missed by photography. The entire post-equatorial retina can be examined with this technique, whereas even seven-field photography misses about 17% of the retina.2The technical failure rate of photography is high and has been reported to be 14.4%, compared with only 2.2% for ophthalmoscopy in the same group.3 In our district the technical failure rate of slit lamp biomicroscopy is 0.2%.4 Over-reading by trained graders has been reported in studies of photographic screening.2 One study looked at the performance of retina specialists compared with a standardised reading centre and found an overall agreement of only 74%, concluding that there was a significant discrepancy in concordance.5The main reason for choosing digital photography seems to be the ease of audit, with no need for repeat examinations. However, the high technical failure rate of photography means that more re-examinations will be needed with this technique; a 5-10% re-examination rate for audit purposes in an ophthalmoscopic screening system compares favourably with a 15% re-examination rate because of technical failure in a photographic screening system.3,4We also have concerns about the cost of the different screening systems. A new national training infrastructure will be needed to provide accredited training for photographic screeners, whereas integrating retinopathy screening skills into the training of optometrists would be fairly easy. Thus training and accreditation costs would be lower for screening by optometrists.The main cost of this screening is the fee paid to the optometrists. The national committee estimates this at £20, but in our district it is £15. This alone would reduce the overall cost by £60 000 a year for a programme that had 12 000 primary screen events a year. Most optometrists already have the necessary equipment, and thus the cost of new equipment for screening would be unlikely to be great." @default.
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- W966168316 date "2001-10-27" @default.
- W966168316 modified "2023-10-14" @default.
- W966168316 title "National screening programme for diabetic retinopathy" @default.
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- W966168316 doi "https://doi.org/10.1136/bmj.323.7319.998" @default.
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