Early detection of diabetic retinopathy

Eyesi direct ophthalmoscope simulator: an effective training tool for medical undergraduates

INTRODUCTION

Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training.

METHODS

Medical undergraduates were randomly assigned to Group A or B (n = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire.

RESULTS

After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 (P < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates' tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training.

CONCLUSION

According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.

Comparative study of the polaroid and digital non-mydriatic cameras in the detection of referrable diabetic retinopathy in Australia

AIM

To show that the non-mydriatic retinal camera (NMRC) using polaroid film is as effective as the NMRC using digital imaging in detecting referrable retinopathy.

METHODS

A series of patients with diabetes attending the eye out-patients department at the Royal Victorian Eye and Ear Hospital had single-field non-mydriatic fundus photographs taken using first a digital and then a polaroid camera. Dilated 30 degrees seven-field stereo fundus photographs were then taken of each eye as the gold standard. The photographs were graded in a masked fashion. Retinopathy levels were defined using the simplified Wisconsin Grading system. We used the kappa statistics for inter-reader and intrareader agreement and the generalized linear model to derive the odds ratio.

RESULTS

There were 196 participants giving 325 undilated retinal photographs. Of these participants 111 (57%) were males. The mean age of the patients was 68.8 years. There were 298 eyes with all three sets of photographs from 154 patients. The digital NMRC had a sensitivity of 86.2%[95% confidence interval (CI) 65.8, 95.3], whilst the polaroid NMRC had a sensitivity of 84.1% (95% CI 65.5, 93.7). The specificities of the two cameras were identical at 71.2% (95% CI 58.8, 81.1). There was no difference in the ability of the polaroid and digital camera to detect referrable retinopathy (odds ratio 1.06, 95% CI 0.80, 1.40, P = 0.68).

CONCLUSION

This study suggests that non-mydriatic retinal photography using polaroid film is as effective as digital imaging in the detection of referrable retinopathy in countries such as the USA and Australia or others that use the same criterion for referral.

The detection of diabetic retinopathy by Australian optometrists

BACKGROUND

Diabetes mellitus is a systemic disease affecting approximately 750,000 Australians of whom more than 70,000 are Queenslanders. It can have serious ocular consequences and patients with diabetes require regular eye examinations to determine the degree of ocular involvement and the stage of retinopathy, if present. It is important that optometrists detect diabetic retinal changes and refer appropriately. We sought to determine the proficiency of optometrists at detecting retinal changes caused by diabetes.

METHODS

The study comprised four parts: 1. Nineteen randomly recruited Australian optometrists practising in Queensland completed a questionnaire on their experiences seeing patients with diabetes. 2. They examined the ocular fundi of 10 patients. 3. They viewed retinal slides of 12 additional cases. 4. They attended a follow-up seminar on diabetes and the cases. They were informed that the patients did not necessarily have diabetes and instructed not to discuss the condition with the patient or their colleagues. The optometrists were allowed seven minutes per station to examine the patient or the slides and write down their responses before moving to the next station.

RESULTS

When the slides and patients were considered together, cases where diabetic retinopathy was present were correctly identified by 94.0 per cent of the optometrists and cases where retinopathy was not present were correctly identified by 93.6 per cent of the optometrists. When all assessments were considered together, the correct detection/differential diagnosis rate was 88.3 per cent. Sub-classification of diabetic retinopathy severity agreed with that of the reference examiners in 58.3 per cent of assessments and there was agreement on management in 79.4 per cent of cases. Of the 22 assessments undertaken by each optometrist, there were, on average, 2.5 errors.

CONCLUSION

Randomly selected Australian optometrists are able to detect and grade diabetic retinal changes solely by retinal examination and refer the patients requiring specialist care.

Screening for diabetic retinopathy using a non-mydriatic retinal camera in rural Victoria

PURPOSE

To develop a screening programme for the early detection of diabetic retinopathy using non-mydriatic retinal photography.

METHODS

A community based screening service was offered to all people with known diabetes mellitus in selected townships in the LaTrobe and Goulburn Valleys in Victoria. At the local examination centre, basic sociodemographic information was collected as well as details of previous use of eye care services for the early detection of diabetic retinopathy. The examination included visual acuity (VA), glycosylated haemoglobin level and Polaroid photographs of each fundus using a Canon CR5-45NM non-mydriatic retinal camera (Canon, Tochigiken, Japan). Dilating drops were not used. Photographs were subsequently reviewed and letters were sent to all participants (with copies to their general practitioners) with recommendations for appropriate follow up.

RESULTS

A total of 1177 people with diabetes attended the screening service, which is estimated to be 40% of the total population with known diabetes in the study area. The mean age was 65 years (range 20-94 years); 559 (48%) people reported not having a dilated fundus examination within the past 2 years; 345 (29%) people had never had a dilated fundus examination. Of the 2354 eyes, 2126 (90%) of the photographs were gradable. A total of 704 people (60%) had normal VA and no evidence of diabetic retinopathy, 209 people (18%) had diabetic retinopathy, 101 people (9%) had evidence of other fundus pathology, 42 people (3%) had reduced acuity (< 6/18) in one or both eyes (with no fundus pathology evident) and 121 people (10%) had ungradable photographs in one or both eyes.

CONCLUSIONS

The present study demonstrates the usefulness of a screening programme with non-mydriatic retinal photography as an adjunct to current eye care services for the early detection of diabetic retinopathy.

Use of focus groups to identify health promotion strategies for the early detection of diabetic retinopathy

BACKGROUND

People with diabetes do not regularly utilise eye services for the early prevention of vision loss due to diabetic eye disease. A community-based screening program has been initiated in Victoria to address this issue. To encourage people to take preventive eye health care measures, the most effective health promotion strategies were identified.

METHODS

Thirty-three health professionals were invited to attend focus groups. A sample of 35 people with diabetes was approached by their GPs or diabetes educators because of their motivation to participate in diabetes activities. Each group consisted of 10 members. Discussion points included the type of education messages available to people with diabetes; use of eye services among the participants with diabetes; and strategies required promoting the screening service.

RESULTS

Five focus groups were conducted. The discussions highlighted that a great deal could be achieved by using local community networks to promote the benefits of early detection of diabetic retinopathy and local screening program. The group members recommended that particular attention be directed to general practitioners and their distribution of materials to patients. Key issues for planning and implementing the program were highlighted. The groups urged development of strategies to encourage people with diabetes in rural Victoria to participate in a program for the early detection of diabetic retinopathy.