Diabetic Retinopathy Screening at the Point of Care (diabetic retinopathy (DR) SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services
Authors' conclusion
There is a high prevalence of vision-threatening and undiagnosed DR among patients attending high-risk tertiary clinics in Western Sydney. Point-of-care DR screening using portable, mydriatic photography demonstrates potential as a model of care which is easily accessible, targeted for high-risk populations and substantially enhances DR detection.
Study context
- Population
- Patients with diabetes attending foot ulcer or integrated care diabetes clinics at two Western Sydney hospitals (low socioeconomic region)
- Participants
- 273 patients
- Exposure
- Portable non-mydriatic fundus photography and ERG vs mydriatic photography (reference standard)
- Outcome
- Prevalence of DR; diagnostic utility (sensitivity, specificity) of point-of-care screening
Methodological detailstwo hospitals, point-of-care screening, mydriatic photographs as reference standard
- Two hospitals
- Point-of-care screening
- Mydriatic photographs as reference standard
Main finding
As reported in the abstract
Any DR
39.6%
Vision-threatening diabetic retinopathy (VTDR)
15.8%
Previously undiagnosed among any DR
59.3%
Previously undiagnosed among VTDR
62.8%
Observational data: associations, not effects.
Further findings
| Outcome | Non-mydriatic photography | ERG | Mydriatic photography |
|---|---|---|---|
| Diagnostic accuracy for any DR and screening failure rate | |||
| Sensitivity | 20.2% | 72.5% | — not stated in the abstract |
| Specificity | 99.5% | 70.1% | — not stated in the abstract |
| Screening failure rate | 56.7% | — not stated in the abstract | — not stated in the abstract |
| Failure rate | — not stated in the abstract | 15.0% | 7.6% |
| Optimal DR cut-off score | — not stated in the abstract | 22 | — not stated in the abstract |
— not stated in the abstract
Predictors of DR (multivariate logistic regression)
- Strong predictors of DR: eGFR ≤29 mL/min/1.73 m², HbA1c ≥7.0%, pupil size <4 mm, DM duration 5-24 years, RETeval score ≥22
Original publication
Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services. BMJ Open Diabetes Res Care. Published 2 August 2023. doi:10.
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