Non-Mydriatic Fundus Camera Screening for Referral-Warranted Diabetic Retinopathy in a Northern California Safety-Net Setting.

BACKGROUND AND OBJECTIVE

To compare nonmydriatic fundus photography (nFP) screening for diabetic retinopathy (DR) with clinical dilated fundus examination (DFE) in a safety-net setting.

PATIENTS AND METHODS

This was a retrospective, institutional cohort study of 6,911 patients undergoing nFP screening for DR between 2008 and 2012. A subset of 1,521 patients underwent DFE, and clinical DR grade was compared with nFP DR grade.

RESULTS

nFP screening demonstrated 17% prevalence of any DR, with moderate nonproliferative diabetic retinopathy (NPDR) or worse present in 5% of patients. Thirteen percent of photos were unreadable. When compared with DFE, sensitivity and specificity of nFP to detect moderate NPDR or worse were 91% and 97%, respectively. Area under the receiver operating characteristic curve was 0.97.

CONCLUSIONS

The authors' study found 17% of patients screened with nFP had referral-warranted DR. These results demonstrate a use-case of telemedicine to screen large numbers of patients in a safety-net setting, but they also highlight the need for adequate specialty resources to care for referred patients. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:636-642.].