ORIGINAL ARTICLES

PREVALENCE OF DIABETIC RETINOPATHY IN A PRIMARY CARE SETTING USING DIGITAL RETINAL IMAGING TECHNOLOGY

COMMENTARY

Sagili Chandrasekhara Reddy MS(Ophth) FRCS(Glasg), International Medical University

Reddy SC. Commentary on "Prevalence of diabetic retinopathy in a primary care setting using digital retinal imaging technology." Malaysian Family Physician. 2006;1(1):22

The prevalence of diabetic retinopathy as determined by digital retinal imaging technology in this study was surprisingly high: 71.9% overall and 63.9% among those diagnosed less than one year. The prevalence rates are higher than hospital series using dilated direct ophthalmoscopy (44.1% from University Hospital Kuala Lumpur,1 and 48.6% from Hospital University Sains Malaysia2). Is this due to the high sensitivity of retinal photography or false positives? We cannot ascertain this in the absence of verification by a gold standard. Undilated ophthalmoscopy by non-ophthalmologists has low sensitivity;3 hence retinal photography appears to offer a solution for the currently low screening rate of diabetic eyes. However, its high cost (prices vary depending on the model) raise the question as to whether it is a cost effective approach in primary care. Study in UK general practice showed that the addition of fundus photography to routine direct ophthalmoscopy improved the detection of sight-threatening retinopathy.4 In deciding whether to provide fundus photography service, general practitioners should

Address for correspondence: Assoc Prof Dr SC Reddy, Department of Ophthalmology, International Medical University, IMU Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan. Tel: 06-7677798, Fax: 06-7677709, Email: sagili_chandrasekharareddy@imu.edu.my

REFERENCES

  1. Teoh GH, Yow CS, Ngan A, Zaini A. Prevalence of diabetic retinopathy in the University Hospital diabetic population. Med J Malaysia. 1983 Mar;38(1):77-9 [PubMed]
  2. Shriwas SR, Rahman Isa AB, Reddy SC, et al. Risk factors for retinopathy in diabetes mellitus in Kelantan, Malaysia. Med J Malaysia. 1996 Dec;51(4):447-52 [PubMed]
  3. Fong DS, Aiello LP, Ferris FL 3rd, Klein R. Diabetic retinopathy. Diabetes Care. 2004 Oct;27(10):2540-53 [PubMed] [Full text]
  4. O’Hare JP, Hopper A, Madhaven C, et al. Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care. BMJ. 1996 Mar 16;312(7032):679-82
    [PubMed] [Full text]