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Annals of Family Medicine 2:218-220 (2004)
© 2004 Annals of Family Medicine, Inc.
doi: 10.1370/afm.67
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Accuracy of Screening for Diabetic Retinopathy by Family Physicians

James M. Gill, MD, MPH1, David M. Cole, EpD2, Harry M. Lebowitz, MD2 and James J. Diamond, PhD2

1 Christiana Care Health Services, Wilmington, Del
2 Thomas Jefferson Medical University, Philadelphia, Pa

CORRESPONDING AUTHOR: James M. Gill, MD, MPH, Christiana Care Health Services, 1401 Foulk Rd, Wilmington, DE 19803, jgill{at}christianacare.org

BACKGROUND We wanted to examine the accuracy of family physicians’ screening for diabetic retinopathy using standardized criteria and a nonmydriatic ophthalmoscope.

METHODS Eleven family physicians assessed 28 standardized patients with diabetes mellitus using the PanOptic ophthalmoscope. Their assessments of whether the patients required referral to an ophthalmologist were compared with the reference standard of retinal diagrams.

RESULTS The mean sensitivity for the family physicians was 87% (95% confidence interval [CI], 83%–91%) with a specificity of 57% (95% CI, 46%–68%). Overall agreement was moderate, with a mean {kappa} = .43 (95% CI, 0.39%–0.47%).

CONCLUSIONS Using standardized criteria and a nonmydriatic ophthalmoscope, family physicians were fairly accurate in screening patients for diabetic retinopathy. Whereas this technique is not sufficiently accurate to replace routine referral for all patients with diabetes, it can be used to improve care for those patients who fail to get routine eye screenings.

Key Words: Diabetes mellitus • primary care • quality of health care • diabetic retinopathy • sensitivity and specificity




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TRACK Comments:

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Eye exams important but often overlooked
Katrina E Donahue
Annals of Family Medicine, 26 May 2004 [Full text]
Is this practical for everyday practice use?
Lawrence M. Markman, M.D.
Annals of Family Medicine, 5 Jun 2004 [Full text]
Agree with limited practicality of routine retinopathy screening
James M Gill
Annals of Family Medicine, 5 Jun 2004 [Full text]
Intervention in our non-adherent patients that may help save their sight
Richelle J. Koopman
Annals of Family Medicine, 10 Jun 2004 [Full text]
Ophthalmoscopic technique
Eugene C Corbett, Jr., MD
Annals of Family Medicine, 9 Aug 2004 [Full text]

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