Difficulties with Detecting Diabetic Retinopathy in Primary Care Screening - European Medical Journal

Difficulties with Detecting Diabetic Retinopathy in Primary Care Screening

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IN PRIMARY CARE SETTINGS, fundoscopy screening has been found to have both low sensitivity and accuracy in detecting diabetic retinopathy. 

The study was carried out in a cohort of 59 patients with diabetes who had both a primary care exam and a professional eye exam, performed by either an ophthalmologist or optometrist. It was discovered that primary care exams had a sensitivity for detecting eye disease of 0% (95% confidence interval [CI]: 0.0–14.9) and an accuracy of 62.7% (95% CI: 50.0–73.9).  

Electronic records of 767 patients were randomly selected and included in a wider retrospective analysis in the study. Of these, only 12% received a fundoscopy examination during a primary care visit. This low percentage was partly attributed to seeing a nurse practitioner rather than a doctor, where odds for patients of being offered a fundoscopy were 77% lower (95% CI: 0.04–0.79; p=0.049). Researchers also found that patients had a greater likelihood of receiving a fundoscopy examination if their primary care practitioner had been in practice longer; for every 10 years, there was a 26% higher chance that patients would be given a fundoscopy at least once annually (95% CI: 1.01–1.59; p=0.04). 

Patients with Type 1 or 2 diabetes were examined at one of 28 clinics in the Duke Health Primary Care network, North Carolina, USA, during 2019. Half of the cohort were female, and the median patient age was 64. Among the 767 patients, 40.1% did not have a professional eye care visit and did not receive a fundoscopic examination from their primary care provider. 

Lead study author, Anthony Kuo, Duke University, Durham, North Carolina, USA, and colleagues stated: “These findings suggest that fundoscopy may be a suboptimal method to screen for diabetic retinopathy in primary care.” They went on to note that despite previous studies indicating that training may improve the accuracy of primary care professionals, there have been difficulties in implementing this on a general population level. 

No patient demographics or specific clinical factors were consistent with being offered fundoscopy from a primary care provider, including age, diabetes type, insulin use, sex, race, ethnicity, insurance type, or HbA1c level. Limitations pointed out by researchers were the review of electronic health records retrospectively, and the localised setting of the patients within one healthcare system.

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