[Screening for ophthalmic disease in the diabetic patient: eye fundus examination by non-mydriatic retinography with or without examination of visual acuity and intraocular pressure]

Abstract

Objective: To screen for eye disease in diabetic patients by performing only an eye fundus examination with non-mydriatic retinography, or a more extensive ophthalmological examination including visual acuity (VA) and ocular tonometry.

Design: A cross-sectional multicentre study with cohort comparison.

Subjects: Diabetic patients who attended 6 Primary Health Care Centres (PCC).

Interventions: complete ophthalmological examination of patients in 3 PCC: VA examination, intraocular pressure (IOP) measurement and eye fundus examination with non-mydriatic retinography (egphNMC). Partial examination of patients of the other 3 PCC: only an eye fundus examination with non-mydriatic retinography. Patients with a suspicion of eye disease were referred to the Ophthalmology Department.

Results: A complete ophthalmological examination was carried out on 938 patients (71%) and a partial examination in 383 (29%).

Diagnosis: a) suspicion of diabetic retinopathy (DR): 123 cases (9.3%), with no differences between the complete examination (9.1%) and partial examination (9.3%); b) suspicion of glaucoma: 89 cases (8.1% in complete examination and 3.4% in partial (suspicion due to papillary alteration in egphNMC)); c) VA changes: 169 cases (18%) in complete examination. Referral to ophthalmology service was made in 41% of patients with complete examination and 18% in patients with partial examination.

Conclusions: Using only back of the eye examination with a non-mydriatic camera, a high percentage of diabetic patients were not diagnosed with an eye disease distinct to diabetic retinopathy (VA and IOP alterations), which are probably associated to a higher percentage of cataracts and glaucoma in this group.