Clinical examination and fundus photography in diabetic retinopathy screening



Diabetic retinopathy, Optical coherence tomography, Clinical examination, Fundus Photography


Background/Aim: An increasing number of patients and an ophthalmologist shortage in some areas necessitate reaching more patients in a shorter time to decrease the burden of devastating visual complications of diabetic retinopathy (DR). Screening and diagnosing DR using fundus photographs may save time and effort. In this study, we aimed to report the results of DR screening in a Turkish treatment-naive diabetes mellitus (DM) patient group by examining fundus photographs taken with ETDRS protocol and compare them with clinical examination and optical coherence tomography (OCT) findings. Methods: Two hundred and ninety-two eyes of 150 DR treatment-naive DM patients were included in this cross-sectional study. Complete ophthalmic examination was performed by a single examiner. Fundus photograph acquisition according to ETDRS protocol and OCT were performed by an experienced technician. Fundus photographs were evaluated by the same examiner who was blinded to patient names, at the end of the study period. Results: Two hundred and ninety-two eyes of 150 DR treatment-naive DM patients’ findings were evaluated. According to stereoscopic fundus examination, 76 (26%) eyes showed no signs of DR, 76 (26%) eyes showed mild non-proliferative diabetic retinopathy (NPDR) signs, 44 eyes (15.1%) showed moderate NPDR signs, 78 eyes (26.7%) showed severe NPDR signs, and 18 eyes (6.2%) showed PDR signs. According to images acquired with the ETDRS protocol, 79 (27.1%) eyes showed no signs of DR, 81 (27.7%) eyes showed mild NPDR signs, 50 eyes (17.1%) showed moderate NPDR signs, 68 eyes (23.3%) showed severe NPDR signs, and 14 eyes (4.8%) showed PDR signs. Clinical examination and fundus photography showed substantial agreement in detecting DR severity (Kappa value: 0.78 P<0.001). Diabetic macular edema (DME) was present in 106 and 68 eyes according to OCT and ETDRS fundus photographs, respectively. These two methods showed moderate agreement in detecting DME (Kappa value: 0.57, P<0.001). ETDRS fundus photography is an effective method for screening DR severity in a Turkish DR population. When patients with no evident DR findings were excluded, we found a statistically significant negative correlation (P<0.001, Spearman Rho coefficient: -0.306) between central retinal thickness and best-corrected visual acuity, as expected. Conclusion: For screening DR severity, ETDRS fundus photography is an effective method in a Turkish DR population.


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Research Article

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Erkan E, Dündar S, Akyüz Ünsal A İpek. Clinical examination and fundus photography in diabetic retinopathy screening. J Surg Med [Internet]. 2021 May 1 [cited 2022 Aug. 8];5(5):444-8. Available from: