Search

Background: Diabetic retinopathy (DR) is one of the most common causes of vision loss worldwide; however, the limited access of the majority of the population to ophthalmologists and the lack of awareness among patients highlight the important role of family physicians in diagnosing this problem. This study aimed to determine the accuracy of direct ophthalmoscopy for DR screening by family physicians. Method: In this cross-sectional study, 121 patients were examined by three groups of physicians using direct ophthalmoscopy. Each of the two first groups (A and B) consisted of four family physicians who received written instructions and educational software regarding DR diagnosis, with group A also receiving a 2-h in-person class. The third group included four ophthalmologists (O). Based on the severity of diagnosis, results were compared with standard diagnosis provided by a retina fellow student. Results: Sensitivity of groups A, B, and O was calculated as 59%, 51%, and 78%, respectively. The specificity of the groups was also measured as 75.6%, 86.5%, and 80.0%, respectively. The study groups did not demonstrate a significant difference in regard to diagnostic parameters (p > 0.05). An additional analysis was conducted, only focusing on the diagnosis of severe DR, where the specificity of all groups improved. Still, no significant difference was observed between groups (p > 0.05). Conclusion: This was the first study investigating the role of family physicians in DR screening in Iran. The results indicated that trained family physicians could be reliable enough for diagnosing DR with the help of a direct ophthalmoscope. They can be used as a part of a referral protocol in deprived areas where access to an ophthalmologist is difficult. [ABSTRACT FROM AUTHOR]

Purpose. To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb. Methods. In this mixed model study, a web application called the "Iranian Retinopathy Teleophthalmology Screening (IRTOS)" was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital. Results. Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively. Conclusions. Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs. [ABSTRACT FROM AUTHOR]