BMJ 2002;324:849 ( 6 April )

Letters

National screening programme for diabetic retinopathy

    Digital image may be better for screening
    Screening by retinal photography offers holistic package of diabetic care
    Authors' reply

Digital image may be better for screening

The first 150 words of the full text of this article appear below.

EDITOR---I work as an ophthalmic photographer, but I have no involvement in screening. Prasad et al assert that screening for diabetic retinopathy by optometrists is superior to photographic screening.1 This is questionable for several reasons.

Firstly, biomicroscopy detects macular oedema, and more of the retina can be examined. Both are true, but macular oedema will be accompanied by reduced visual acuity, which is easily measured. Treatable retinopathy is most likely to be found around the posterior pole. Is there an obvious advantage in examining the periphery?

Secondly, photography has a high technical failure rate compared with ophthalmology. Careful reading of the paper cited as evidence for this does not give a failure rate for photography of 14%. Of 326 patients, six were ungradable by any means. Twelve of the remaining 320 patients could not be photographed because of posture or tremor. A further 34 patients were ungradeable; 18 of them had opacities . . . [Full text of this article]
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Rapid Responses:

Read all Rapid Responses

An optometric pespective on screening
Trevor J Warburton
bmj.com, 6 Apr 2002 [Full text]
Clarification regarding 'technical failure'
Somdutt Prasad
bmj.com, 15 Apr 2002 [Full text]
Correction to Author's reply
Somdutt Prasad
bmj.com, 15 Apr 2002 [Full text]
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