• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of bmjBMJ helping doctors make better decisionsSearch bmj.comLatest content
BMJ. Oct 28, 1995; 311(7013): 1131–1135.
PMCID: PMC2551056

Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study.

Abstract

OBJECTIVE--To evaluate different methods for community based screening for sight threatening diabetic eye disease. DESIGN--Prospective study. SETTING--Mobile screening unit visiting inner city community clinics; hospital assessment clinic (tertiary centre). SUBJECTS--395 diabetic patients registered with four general practices in an inner city location. INTERVENTIONS--Community based photography with mydriasis and direct ophthalmoscopy through dilated pupils by an experienced ophthalmologist, both compared with reference standard of slit lamp biomicroscopy by a consultant specialist in medical retinal disease. MAIN OUTCOME MEASURES--Sensitivity and specificity of screening method and prevalence of sight threatening diabetic eye disease (moderate preproliferative retinopathy, circinate maculopathy, exudate within 1 disc diameter of fixation, other diabetes related eye disease). RESULTS--358 subjects underwent photography, 326 attended hospital clinic for ophthalmoscopy, and six were ungradable on photographs and biomicroscopy, leaving 320 for analysis. Of these 295 (91%) attended clinic within four months of photography. Sensitivity of detection of eye disease by photography was 89% (95% confidence interval 80% to 98%), significantly better than for direct ophthalmoscopy (65% (51% to 79%)). Analysis of patients with false negative results indicated possible improvement of photographic sensitivity to 93% by addition of stereoscopic macular pair photographs. Specificity of detection of sight threatening eye disease was 86% (82% to 90%) for photography and 97% (95% to 99%) for direct ophthalmoscopy. CONCLUSIONS--Since high sensitivity is essential for an effective screening programme, a photographic method should be considered as preferred option in national, community based screening programmes. Even in the hands of an experienced ophthalmologist, direct ophthalmoscopy is limited by weaknesses inherent to the instrument.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Savolainen EA, Lee QP. Diabetic retinopathy - need and demand for photocoagulation and its cost-effectiveness: evaluation based on services in the United Kingdom. Diabetologia. 1982 Aug;23(2):138–140. [PubMed]
  • Kohner EM, Barry PJ. Prevention of blindness in diabetic retinopathy. Diabetologia. 1984 Mar;26(3):173–179. [PubMed]
  • Javitt JC, Canner JK, Sommer A. Cost effectiveness of current approaches to the control of retinopathy in type I diabetics. Ophthalmology. 1989 Feb;96(2):255–264. [PubMed]
  • Foulds WS, McCuish A, Barrie T, Green F, Scobie IN, Ghafour IM, McClure E, Barber JH. Diabetic retinopathy in the West of Scotland: its detection and prevalence, and the cost-effectiveness of a proposed screening programme. Health Bull (Edinb) 1983 Nov;41(6):318–326. [PubMed]
  • Sussman EJ, Tsiaras WG, Soper KA. Diagnosis of diabetic eye disease. JAMA. 1982 Jun 18;247(23):3231–3234. [PubMed]
  • Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular edema. Long-term visual results. Ophthalmology. 1991 Oct;98(10):1594–1602. [PubMed]
  • Wareham N, Greenwood R. Screening for diabetic retinopathy using non-mydriatic fundus photography. Diabet Med. 1991 Aug-Sep;8(7):607–608. [PubMed]
  • Buxton MJ, Sculpher MJ, Ferguson BA, Humphreys JE, Altman JF, Spiegelhalter DJ, Kirby AJ, Jacob JS, Bacon H, Dudbridge SB, et al. Screening for treatable diabetic retinopathy: a comparison of different methods. Diabet Med. 1991 May;8(4):371–377. [PubMed]
  • Williams R, Nussey S, Humphry R, Thompson G. Assessment of non-mydriatic fundus photography in detection of diabetic retinopathy. Br Med J (Clin Res Ed) 1986 Nov 1;293(6555):1140–1142. [PMC free article] [PubMed]
  • Moss SE, Klein R, Kessler SD, Richie KA. Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy. Ophthalmology. 1985 Jan;92(1):62–67. [PubMed]
  • Mohan R, Kohner EM, Aldington SJ, Nijhar I, Mohan V, Mather HM. Evaluation of a non-mydriatic camera in Indian and European diabetic patients. Br J Ophthalmol. 1988 Nov;72(11):841–845. [PMC free article] [PubMed]
  • Klein R, Klein BE, Neider MW, Hubbard LD, Meuer SM, Brothers RJ. Diabetic retinopathy as detected using ophthalmoscopy, a nonmydriatic camera and a standard fundus camera. Ophthalmology. 1985 Apr;92(4):485–491. [PubMed]
  • Burns-Cox CJ, Hart JC. Screening of diabetics for retinopathy by ophthalmic opticians. Br Med J (Clin Res Ed) 1985 Apr 6;290(6474):1052–1054. [PMC free article] [PubMed]
  • Taylor R, Lovelock L, Tunbridge WM, Alberti KG, Brackenridge RG, Stephenson P, Young E. Comparison of non-mydriatic retinal photography with ophthalmoscopy in 2159 patients: mobile retinal camera study. BMJ. 1990 Dec 1;301(6763):1243–1247. [PMC free article] [PubMed]
  • Ryder RE, Vora JP, Atiea JA, Owens DR, Hayes TM, Young S. Possible new method to improve detection of diabetic retinopathy: Polaroid non-mydriatic retinal photography. Br Med J (Clin Res Ed) 1985 Nov 2;291(6504):1256–1257. [PMC free article] [PubMed]
  • Schachat AP, Hyman L, Leske MC, Connell AM, Hiner C, Javornik N, Alexander J. Comparison of diabetic retinopathy detection by clinical examinations and photograph gradings. Barbados (West Indies) Eye Study Group. Arch Ophthalmol. 1993 Aug;111(8):1064–1070. [PubMed]
  • Kinyoun JL, Martin DC, Fujimoto WY, Leonetti DL. Ophthalmoscopy versus fundus photographs for detecting and grading diabetic retinopathy. Invest Ophthalmol Vis Sci. 1992 May;33(6):1888–1893. [PubMed]
  • Altman DG, Bland JM. Diagnostic tests. 1: Sensitivity and specificity. BMJ. 1994 Jun 11;308(6943):1552–1552. [PMC free article] [PubMed]
  • Leese GP, Ahmed S, Newton RW, Jung RT, Ellingford A, Baines P, Roxburgh S, Coleiro J. Use of mobile screening unit for diabetic retinopathy in rural and urban areas. BMJ. 1993 Jan 16;306(6871):187–189. [PMC free article] [PubMed]
  • Sparrow JM, McLeod BK, Smith TD, Birch MK, Rosenthal AR. The prevalence of diabetic retinopathy and maculopathy and their risk factors in the non-insulin-treated diabetic patients of an English town. Eye (Lond) 1993;7(Pt 1):158–163. [PubMed]
  • Kohner EM. Detecting diabetic retinopathy. BMJ. 1991 Jan 19;302(6769):a176–176. [PMC free article]
  • Rogers D, Bitner-Glindzicz M, Harris C, Yudkin JS. Non-mydriatic retinal photography as a screening service for general practitioners. Diabet Med. 1990 Feb;7(2):165–167. [PubMed]
  • Jones D, Dolben J, Owens DR, Vora JP, Young S, Creagh FM. Non-mydriatic Polaroid photography in screening for diabetic retinopathy: evaluation in a clinical setting. Br Med J (Clin Res Ed) 1988 Apr 9;296(6628):1029–1030. [PMC free article] [PubMed]
  • Forrest RD, Jackson CA, Yudkin JS. Screening for diabetic retinopathy--comparison of a nurse and a doctor with retinal photography. Diabetes Res. 1987 May;5(1):39–42. [PubMed]
  • Kleinstein RN, Roseman JM, Herman WH, Holcombe J, Louv WC. Detection of diabetic retinopathy by optometrists. J Am Optom Assoc. 1987 Nov;58(11):879–882. [PubMed]
  • Jacob J, Stead J, Sykes J, Taylor D, Tooke JE. A report on the use of technician ophthalmoscopy combined with the use of the Canon non-mydriatic camera in screening for diabetic retinopathy in the community. Diabet Med. 1995 May;12(5):419–425. [PubMed]
  • Ryder B. Screening for diabetic retinopathy. BMJ. 1995 Jul 22;311(6999):207–208. [PMC free article] [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...