Screening for diabetic retinopathy-a meta-analysis

January 01, 0001

Screening for diabetic retinopathy-a meta-analysis

These Australian authors performed a meta-analysis to examine how mydriasis and the medical qualifications of photographers who take retinal photographs influence the accuracy of screening for diabetic retinopathy (DR). They included studies that measured the sensitivity and specificity of tests designed to detect any DR, sight-threatening DR, or macular edema. Using random-effects logistic regression, they examined the effect of variations in mydriatic status and in medical qualifications of photographers on sensitivity and specificity.

They found: "Only the category of ‘any DR’ had sufficient consistency in definition, number of studies (n = 20), and number of assessments (n = 40) for meta-analysis. Variations in mydriatic status did not significantly influence sensitivity (OR, 0.89) or specificity (OR, 0.94). Variations in medical qualifications of photographers did not significantly influence sensitivity (OR, 1.25). Specificity of detection of any DR was significantly higher for screening methods that use a photographer with specialist medical or eye qualifications (OR, 3.86)."

The authors concluded: "Outreach screening is an effective alternative to on-site specialist examination. It has potential to increase screening coverage of high-risk patients with DR in remote and resource-poor settings without the risk of missing DR and the opportunity to prevent vision loss. Our analysis was confined to the presence or absence of DR. Future studies should use consistent DR classification schemes to facilitate further analysis."

Photographic approach to routine screening for diabetic retinopathy may be most effective way to reach the majority of diabetic patients.

For the full abstract, click here.

Arch Ophthalmol 129(4):435-444, April 2011 © 2011 to the American Medical Association
Screening for Presence or Absence of Diabetic Retinopathy-A Meta-analysis. Peter Bragge, Russell L. Gruen, Marisa Chau, Andrew Forbes, Hugh R. Taylor. Correspondence to Dr. Taylor: [email protected]

Category: F. Eye. Keywords: diabetic retinopathy, screening, mydriasis, photography, meta- analysis of diagnostic test studies, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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