clinical utility of a non-mydriatic retinal camera in a diabetes clinic

we aim to evaluate a non-mydriatic retinal camera as a safe and efficacious screening tool, for diabetic retinopathy, in diabetes centers. 221 consecutive patients attending a Diabetes Center submitted to retinal photographs using a non-mydriatic camera. Patients were included if they had not had previous laser therapy and if they had a formal ophthalmologic consultation within 6 months of the photography Four endocrinologists reviewed the retinal photographs and recommended an interval [urgent referral, early referral, non-referral] for ophthalmologic assessment. Endocrinologists' grades were compared against the gold standard of ophthalmological findings. The endocrinologists were privy only to the patient's age, type and duration of diabetes mellitus. Twenty-seven cases were deemed as requiring early referral by the ophthalmologists. The endocrinologists agreed with ophthalmologist referral times in 27, 26, 23 and 27 cases respectively. Two cases requiring urgent referral according to the ophthalmologists were also judged as requiring urgent referral by all endocrinologists. A mean sensitivity of 95.4% [95% CI 88.5%-100%] was attained. The use of a non-mydriatic camera to determine need for ophthalmologic referral was found to be safe and efficacious, with no serious delays in referral noted. On average this tool can safely defer 53.5% of routine ophthalmologic referrals without any risk to the patient's eyesight

Prevalence of visible retinopathy in Saudi diabetics and its correlation with plasma viscosity and histocompatibility antigens

Of 2341 Saudi diabetic patients registered with the Diabetic Centre at the Ministry of Health in the eastern province of Saudi Arabia, 957 consecutive patients [IDDM = 87, NIDDM = 870] were examined for evidence of retinal changes. One hundred and fifty three [16%] had background retinopathy; maculopathy was seen in eight cases [1%] and 25 patients [3%] had proliferative retinopathy. Thus the combined prevalence of retinopathy in the present series [i. e. IDDM + NIDDM] was approximately 20%. In IDDM, however, it was seen in 32% cases whereas only 18% of the non-insulin dependent group showed these changes. This is in contrast to two previous reports from this country. Highest incidence of retinopathy [68%] was seen only in those who had the disease for 15 years or more. Furthermore, 43% of all diabetics had raised plasma viscosity [ie > 1.73CP]. A greater proportion of patients with retinopathy had increased plasma viscosity as compared with those who had apparently normal retina suggesting its complementary pathogenetic role. Moderately raised plasma viscosity [1.93 - 2.12CP] was however, seen in association with maculopathy in patients with IDDM. However, 15 of the 17 cases with proliferative retinopathy and all 5 cases with maculopathy in patients with NIDDM had moderately raised plasma viscosity. Two cases with proliferative retinopathy in this group had normal viscosity whereas 5 patients with only background retinopathy had moderately raised plasma viscosity. Similarly 7 cases with no retinal changes had for unknown reasons moderately raised plasma viscosity. In 85% of Saudis with IDDM the disease was associated with either HLA DR3, DR4 or both. The prevalence of HLA DR3 appeared more frequent [65%] in Saudi diabetics than their caucasian counterpart [46%] but it was not significantly associated with the prevalence or the severity of retinopathy