Screening for diabetic retinopathy in a rural French population with a mobile non-mydriatic camera

Beynat, J.; Charles, A.; Astruc, K.; Metral, P.; Chirpaz, L.; Bron, Alain M.; Creuzot‐Garcher, Catherine

doi:10.1016/j.diabet.2008.07.002

Cited by 34 publications

(13 citation statements)

References 35 publications

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“…This group of older people with ungradable images was informed by mail of the need to be referred to an ophthalmologist for a complete examination of the fundus by biomicroscopy in order to screen for AMD lesions. In comparison with a diabetic retinopathy screening using a nonmydriatic fundus camera which included younger patients without ocular comorbidities than cataract, the rate of ungradable images is similar [12]. The prevalence of AMD will increase in the future with a rise in numbers of the elderly population.…”

Section: Discussionmentioning

confidence: 99%

“…Large-scale screening may permit the development of preventive information and treatment for patients who are at risk of visual loss. Previous studies had shown the clinical interest in detecting earlier AMD on fundus photographs [6,7,8,9,10,11,12,13,14,15]. The 5-year risk of late AMD (grade 4) after diagnosis of early AMD (grade 2 or 3) by fundus photography had been demonstrated in the AREDS (Age-Related Eye Disease Study) Report No.…”

Section: Discussionmentioning

confidence: 99%

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Age-Related Macular Degeneration Screening Using a Nonmydriatic Digital Color Fundus Camera and Telemedicine

et al. 2013

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Purpose: To investigate the use of a nonmydriatic digital color fundus camera and telemedicine as screening tools for age-related macular degeneration (AMD). Methods: Nonmydriatic color fundus photography was performed on patients consulting health examination centers and transmitted by telemedicine to an ophthalmology department. Rates for different grades of AMD were calculated and also statistically related to the presence or absence of risk factors. Results: Among the 1,022 patients screened, a total of 1,363 color fundus photographs were interpreted, with 80% gradable images, allowing a diagnosis of AMD in 178 photographs. Among all the gradable images, 83.7% had no AMD (grade 0). The rates of AMD at grades 1, 2, 3 and 4 were 8%, 5.6%, 2.3% and 0.4%, respectively. A statistical odds ratio was found between the presence of AMD on fundus photographs and age, familial history of AMD or prior cataract surgery. Conclusions: Nonmydriatic color fundus photography and telemedicine succeeded in screening for AMD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age-Related Macular Degeneration Screening Using a Nonmydriatic Digital Color Fundus Camera and Telemedicine

et al. 2013

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“…In the Burgundy region, a mobile DR screening programme has already proven to be a reliable method to detect patients with an inadequate ocular follow-up or those who have a high risk of complications due to inadequately controlled diabetes or insufficient information about their disease and then to reintroduce them into the medical health care system [13,26]. Moreover, Taylor et al [27] underlined that using telemedicine-based digital fundus photographs increased the screening ratio in the diabetic population, when compared with the conventional fundus examination.…”

Section: Discussionmentioning

confidence: 99%

“…It allows documentation of the fundus without pupil dilatation, with a trained technician [12]. It was previously demonstrated that an itinerant screening programme is very useful in rural areas to detect diabetics who do not have a regular examination and patients who require further information, examination and a regular ophthalmic and medical follow-up [11,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a Mobile Diabetic Retinopathy Screening Campaign to Encourage Diabetics to Undergo Regular Ophthalmic Follow-Up

Creuzot‐Garcher

Martin-Phipps²,

Beynat³

et al. 2014

Ophthalmic Res

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Aim: To evaluate the effectiveness of a mobile diabetic retinopathy (DR) screening campaign with a non-mydriatic camera to encourage diabetics to undergo a subsequent ophthalmic follow-up. Methods: Diabetic patients who underwent free DR screening with a non-mydriatic fundus camera were given the recommendation to have an ophthalmic visit, in a time frame suited to the DR stage or in case abnormalities in the macula, the optic nerve or intra-ocular pressure were detected. The photographs were performed by a trained orthoptist. The date of the visit to their ophthalmologist and the report of this consultation were recorded. Results: During 5 annual campaigns, 4,699 diabetics were screened. Of the 1,573 ophthalmic examinations recommended at the screening, 1,241 (79%) were actually conducted. A total of 623 new cases of DR were found in the course of this screening campaign, with a fair concordance between the diagnosis suggested at screening and the examination by the ophthalmologist (κ = 0.48). Conclusion: Information and recommendations given during DR screening helped to reintroduce patients to a regular ophthalmic follow-up, at least in the short term.

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“…Camera screening saved 67 sight-years at US$3 900 per sight-year, while the alternative programme saved only 56 sight-years at US$9 800 per sightyear. [11] Although the SA pilot project was performed in an urban setting, similar projects in rural communities in Australia [12] and France [13] proved to be effective. US researchers [14] have also built a prototype mobile fundus camera that will cut costs significantly and potentially make screening for diabetic blindness even more cost-effective.…”

Section: International Comparisonsmentioning

confidence: 99%

Preventing diabetic blindness: A priority for South Africa

2014

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The prevalence of diabetes in South Africa is increasing rapidly, and diabetes is a significant cause of blindness. Diabetic complications can induce a cycle of poverty for affected families. Early detection of retinopathy and appropriate management can prevent blindness. Screening for retinopathy using a mobile retinal camera is highly cost-effective, with costs of screening and follow-up treatment being less than the expense of one year of a disability grant. Such a programme is a prime example of a 'best buy' that should be part of the national diabetes care package. has been established in Iceland for over 30 years. In 1980, 2.4% of Iceland's population was legally blind, but by 2005 the prevalence had dropped to 0.5%. [16] Similarly, Israel's prevalence of preventable blindness dropped by half from 33.8/100 000 in 1999 to 16.6/100 000 in 2008.[17] These declines can be attributed to the availability of treatment and preventive measures and illustrate the importance of implementing treatment guidelines for diabetic vision impairment.In sub-Saharan Africa, countries have utilised other alternatives by task-shifting cataract operations from ophthalmologists to nonphysician cataract surgeons (NPCSs). NPCSs in Kenya, Tanzania and Ethiopia, for example, performed over 77 000 operations in 2000 -2004. [18] Results showed no difference between specialised ophthalmologists and NPCSs in respect of the quality of surgeries conducted. [19] Although the use of NPCSs is not widely accepted, they represent a cost-effective alternative solution. Laser treatment for diabetic retinopathy by appropriately trained doctors at secondary level and district hospitals would be a feasible solution to deal with diabetic retinopathy-related blindness in SA. 'Best buys' for policy makersUnder the current economic circumstances, every ZAR must work more effectively, efficiently and equitably. In order for the SA government to discern a 'best buy' among cost-effective options, it needs access to valid, reliable and comparable information on costs and consequences of policy alternatives. International examples do provide useful information, but this must be complemented by local context-specific evidence. Prevention interventions offer particularly good value, as they produce the largest gain. ConclusionThe use of mobile fundus cameras to screen for diabetic vision impairment is a paradigm of an innovative approach to achieve economies of scale to reduce preventable blindness effectively on a national level. The use of mobile fundus cameras would interface well with the screening strategy recommended by the Ophthalmology Society of South Africa. One of the challenges for the evolving NHI is how value for money and affordability can be balanced across competing priorities. This approach is one example of a 'best buy' that could potentially be incorporated in a diabetes care package. Over the past 18 years Candy has worked on developing information resources in the field of public health. The current focus of her work includes monitoring ...

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Screening for diabetic retinopathy in a rural French population with a mobile non-mydriatic camera

Cited by 34 publications

References 35 publications

Age-Related Macular Degeneration Screening Using a Nonmydriatic Digital Color Fundus Camera and Telemedicine

Age-Related Macular Degeneration Screening Using a Nonmydriatic Digital Color Fundus Camera and Telemedicine

Effectiveness of a Mobile Diabetic Retinopathy Screening Campaign to Encourage Diabetics to Undergo Regular Ophthalmic Follow-Up

Preventing diabetic blindness: A priority for South Africa

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