AUTHOR=Cunha Leonardo Provetti , Figueiredo Evelyn Alvernaz , Araújo Henrique Pereira , Costa-Cunha Luciana Virgínia Ferreira , Costa Carolina Ferreira , Neto José de Melo Costa , Matos Aline Mota Freitas , Oliveira Marise Machado de , Bastos Marcus Gomes , Monteiro Mário Luiz Ribeiro 

TITLE=Non-Mydriatic Fundus Retinography in Screening for Diabetic Retinopathy: Agreement Between Family Physicians, General Ophthalmologists, and a Retinal Specialist

JOURNAL=Frontiers in Endocrinology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2018.00251

DOI=10.3389/fendo.2018.00251

ISSN=1664-2392

ABSTRACT=<sec id="ST1"><title>Purpose</title><p>To determine the level of agreement between trained family physicians (FPs), general ophthalmologists (GOs), and a retinal specialist (RS) in the assessment of non-mydriatic fundus retinography in screening for diabetic retinopathy (DR) in the primary health-care setting.</p></sec><sec id="ST2"><title>Methods</title><p>200 Diabetic patients were submitted to two-field non-mydriatic digital fundus camera. The images were examined by four trained FPs, two GOs, and one RS with regard to the diagnosis and severity of DR and the diagnosis of macular edema. The RS served as gold standard. Reliability and accuracy were determined with the kappa test and diagnostic measures.</p></sec><sec id="ST3"><title>Results</title><p>A total of 397 eyes of 200 patients were included. The mean age was 55.1 (±11.7) years, and 182 (91%) had type 2 diabetes. The mean levels of serum glucose and glycosylated hemoglobin A1c were 195.6 (±87.3) mg/dL and 8.9% (±2.1), respectively. DR was diagnosed in 166 eyes by the RS and in 114 and 182 eyes by GO<sub>1</sub> and GO<sub>2</sub>, respectively. For severity, DR was graded as proliferative in 8 eyes by the RS vs. 15 and 9 eyes by GO<sub>1</sub> and GO<sub>2</sub>, respectively. The agreement between the RS and the GOs was substantial for both DR diagnosis (GO<sub>1</sub><italic>k</italic> = 0.65; GO<sub>2</sub><italic>k</italic> = 0.74) and severity (GO<sub>1</sub><italic>k</italic> = 0.60; GO<sub>2</sub><italic>k</italic> = 0.71), and fair or moderate for macular edema (GO<sub>1</sub><italic>k</italic> = 0.27; GO<sub>2</sub><italic>k</italic> = 0.43). FP<sub>1</sub>, FP<sub>2</sub>, FP<sub>3</sub>, and FP<sub>4</sub> diagnosed DR in 108, 119, 163, and 117 eyes, respectively. The agreement between the RS and the FPs with regard to DR diagnosis was substantial (FP<sub>2</sub><italic>k</italic> = 0.69; FP<sub>3</sub><italic>k</italic> = 0.73; FP<sub>4</sub><italic>k</italic> = 0.71) or moderate (FP<sub>1</sub><italic>k</italic> = 0.56). As for DR severity, the agreement between the FPs and the RS was substantial (FP<sub>2</sub><italic>k</italic> = 0.66; FP<sub>3</sub><italic>k</italic> = 069; FP<sub>4</sub><italic>k</italic> = 0.64) or moderate (FP<sub>1</sub><italic>k</italic> = 0.51). Agreement between the FPs and the RS with regard to macular edema was fair (FP<sub>1</sub><italic>k</italic> = 0.33; FP<sub>2</sub><italic>k</italic> = 0.39; FP<sub>3</sub><italic>k</italic> = 0.37) or moderate (FP<sub>4</sub><italic>k</italic> = 0.51).</p></sec><sec id="ST4"><title>Conclusion</title><p>Non-mydriatic fundus retinography was shown to be useful in DR screening in the primary health-care setting. FPs made assessments with good levels of agreement with an RS. Non-mydriatic fundus retinography associated with appropriate general physicians training is essential for the DR screening.</p></sec>