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PubMed1996

Brightness discrimination test is not useful in screening for open angle glaucoma.

PURPOSE: Brightness discrimination test (BDT) is routinely employed to assess asymmetrical optic nerve dysfunction and has been suggested as a screening test for primary open angle glaucoma (POAG). We tested the reliability and validity of BDT in the diagnosis of POAG. METHODS: The study groups included 34 patients with established primary open angle glaucoma, 20 glaucoma suspects, and 33 age-sex matched controls. Cataract was not an exclusion criterion in these groups. The normal brightness score was determined to be 88% (mean score, 94%-2 SD) in a pilot study. Brightness discrimination test was performed in all subjects by two observers independently. BDT showed an excellent interobserver agreement (weighted Kappa 0.84). RESULTS: The presence of a cataract alone increased the risk of brightness impairment twofold, glaucoma alone increased the risk eightfold, and the presence of both conditions by 17 times compared to those with neither condition. BDT was not a useful test in the diagnosis of POAG (sensitivity 67% and specificity 93%); the ability to detect a significant field defect was also poor (sensitivity 53% and specificity 76%). CONCLUSIONS: There was poor association between decreased brightness scores and asymmetrical field defects as determined by the Humphrey's field analyzer (HFA).

Adult↗
PubMed2001

[A research of infant refraction in Kunming Municipality].

OBJECTIVE: To study the infant refraction, detect ametropia in mass screening refraction and correct the ametropia properly for the treatment and prevention of amblyopia and strabismus as early as possible. METHODS: The refraction status of 1 146 children (2 291 eyes, aged 1 month -3 years) were determined with retinoscopy after tropicamide cycloplegia. RESULTS: The results of statistics showed that 89 eyes (3.88%) had emmetropia, 2 139 eyes (93.37%) hypermetropia, 38 eyes (1.66%) myopia, 560 eyes (24.44%) astigmatism and 25 eyes (1.09%) mixed astigmatism. In cases with ametropia, most of them were mild, and 97 eyes (4.23%) were moderate and severe. Anisometropia occurred in 34 infants (2.97%), and 7 infants (11 eyes, 0.48%) had strabismus. The degree of hypermetropia decreased with the increase of age. The percentage of astigmatism decreased with the age increase (chi(2) = 7.46, P<0.01), and the degree of astigmatism also decreased with the age increase (chi(2) = 26.1l, P < 0.01). Myopia increased with the age increase (chi(2) = 4.06, P < 0.05). CONCLUSIONS: The prevention of amblyopia and strabismus in children should begin at the infant period, and the cases with moderate and severe ametropia should wear eye glasses as early as possible.

Amblyopia↗
PubMed1998

An inner city preschool visual screening programme: long-term visual results.

AIMS: The aim of this study was to investigate the long-term outcome of the treatment of amblyopia as a sequel to preschool screening, which has not hither-to been described. METHODS: All patients originally referred from a preschool screening programme were recalled for examination by letter. 255 patients were reviewed at least 4 years after discharge of which 88 were definitely amblyopic at presentation and 107 were not amblyopic at presentation and were used as controls. RESULTS: 79% of the amblyopes improved or maintained visual acuity after discharge but this was reduced to 42% after an age induced increase (estimated from the controls) was compensated for. The mean drop in visual acuity in the amblyopic eyes which deteriorated was 0.23 (SD 0.15) logMAR units. Stepwise multiple linear regression showed that the best single predictor of post-discharge deterioration in visual acuity was the improvement in visual acuity seen during treatment (R2 = 19%). Eccentric fixation at time of follow up (increasing R2 to 47%) and good presenting acuity (further raising R2 to 57%) contributed additional information, and were both associated with greater post-discharge deterioration in visual acuity. CONCLUSIONS: The majority of amblyopes who attended for follow up maintained or improved their visual acuities after discharge. Those patients who demonstrated deterioration of their amblyopia had usually improved well during the programme and were often fixating eccentrically at follow up.

Amblyopia↗
PubMed1993

The middle-Norway eye-screening study. III. The prevalence of capsular glaucoma is influenced by blood-group antigens.

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p < or = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

Aged↗
PubMed1991

Peripheral color contrast. A new screening test for preglaucomatous visual loss.

A new test of peripheral color contrast is described. A high-definition color monitor driven by a personal computer with a graphics interface card displays an annulus subtending 25 degrees at the eye. The color contrast between the annulus and the background can be varied. Forty-five degrees of the annulus is randomly removed in one of four quadrants. Patients are asked to identify the position of the gap while fixating a central spot. The minimum color contrast between annulus and background at which the identification is possible is between 13-16% for the protan, deuteran, and tritan axis in normal subjects. This threshold value changes little with age, refractive error, or pupillary aperture, and test-retest variability is low. Testing one eye takes only 1-2 min. The test was applied to ocular-hypertensive and glaucomatous patients. All patients with glaucoma had thresholds greater than two standard deviations (SD) above the normal mean. In addition, 97% of glaucoma patients had thresholds greater than four SDs, and 95% had thresholds more than five SDs above the normal mean. Most patients with ocular hypertension and clinical signs indicating a low or medium risk of conversion to glaucoma had thresholds under the upper limit of normal. High-risk patients with ocular hypertension fell into two groups. One approximated to normal; the other had elevated thresholds, which in many cases were more than four SDs above the normal mean. The epidemiologic consequences of this test are discussed.

Adult↗
PubMed2003

Clinical evaluation of an eccentric infrared photorefractor: the PowerRefractor.

PURPOSE: To evaluate the viability of the PowerRefractor as a screening tool for examining refractive errors in large samples of children. METHODS: The variability of the PowerRefractor was estimated using four patients. The refractive error was determined using cyclopentolate and tropicamide as cycloplegic agents and compared to that determined in a non-cycloplegic situation. In a second study, the data provided by the PowerRefractor were compared to results obtained by autorefractor or retinoscopy for 150 children aged from 6 months to 5 years. RESULTS: Variability study. Statistical analysis showed a statistically significant difference between cycloplegic and non-cycloplegic refraction for spherical and cylindrical refractive errors (p<0.0001 in all cases). There was no significant difference between the measurements made using tropicamide and cyclopentolate (p=0.33 and p=0.18, respectively). Comparison study. In 142 of 150 patients the difference between data obtained by the PowerRefractor and an autorefractor was within 1 D (spherical equivalent). However, there was a considerable difference between the data generated by the two methods in the remaining eight patients (up to 16 D). CONCLUSIONS: The PowerRefractor proved to be a reliable tool for estimating refractive errors in young children. The apparatus is easy to handle and the simultaneous examination of both eyes makes the PowerRefractor ideal for obtaining data on refractive errors in large samples.

Adolescent↗
PubMed1992

Costs and methods of preventive visual screening and the relation between esotropia and increasing hypermetropia.

Atkinson has shown that early correction of hypermetropia reduces the incidence of esotropia. If esotropia is reduced by prescribing glasses early, the rate of esotropia-induced amblyopia can be similarly reduced; this would have important economic consequences. We have studied (1) how costs compare to benefits in early visual screening, (2) how videorefraction as used by Atkinson compares to retinoscopy, and (3) whether esotropia is more likely to occur in children who have increasing as opposed to decreasing hypermetropia. The costs of the study so far have been high. It was exceedingly difficult to get all infants invited, come to the clinic and examined. Videorefraction did not compare favourably with retinoscopy in terms of costs and precision, whereas the amount of skill and time needed was approximately equal. The third question, whether esotropia is more likely to occur in children who have increasing as opposed to decreasing hypermetropia, arose from the controversy whether, in the general population, refraction increases or decreases during the first years of life. We found that papers reporting a decrease of hypermetropia in early childhood were studies of large cross-sections of the general population, whereas papers that reported an initial increase originated from ophthalmological practices or strabismus departments. These conflicting results could be reconciled by assuming a population bias: if esotropia is more likely to occur in children with increasing hypermetropia, children with increasing hypermetropia will preferentially be seen by ophthalmologists. It seems natural that children with increasing hypermetropia are more likely to squint, because additional accommodation, needed to overcome increasing hypermetropia, will inevitably confer additional convergence. This relationship has meanwhile been confirmed by others.

Amblyopia↗
PubMed2006

Inferring myopia over the lifecourse from uncorrected distance visual acuity in childhood.

AIM: To report the usefulness of uncorrected distance visual acuity (DVA) at 16 years to "screen" for myopia status and to assess the lifetime risk of myopia, based on a national birth cohort. METHODS: 1867 members of the 1958 British birth cohort for whom there were data on acuity at 16 years had autorefraction, as part of a biomedical survey, at 45 years. Reduced uncorrected DVA at age 16 years (6/12 or worse in both eyes) was compared with adult refraction (spherical equivalent). RESULTS: Only a quarter of individuals in the population studied who had developed myopia by 45 years of age had reduced acuity at 16 years of age. Notably, half of all adults with moderate myopia (-2.99 to -5.99) and 31% (11/35) with severe myopia (> or =-6) had good uncorrected DVA in both eyes at 16 years of age. Thus, sensitivities were low, ranging from 16% for all myopia (cut-off point spherical equivalent -0.5) to 69% for severe myopia (cut-off point spherical equivalent -6). However, a high (91%) lifetime probability of primary myopia (spherical equivalent > or =-0.5) given a reduced uncorrected DVA at 16 years was found. CONCLUSION: In this population, reduced uncorrected DVA in childhood is an inaccurate and inappropriate intermediate "phenotype" for capturing adult myopia status. However, our findings support assessment of DVA in secondary school children as an effective method of identifying refractive error (both myopia and hypermetropia).

Adolescent↗
PubMed1999

[Keratoconus screening with wave-front parameters based on topography height data].

BACKGROUND: The image-forming properties of a keratoconus eye are degraded even in the early stage of this disease. The purpose of this study was to develop keratoconus detection scheme based on topography height data independent of the currently used system which avoids the disadvantages of detection algorithms currently used in clinical practice. PATIENTS AND METHODS: Eighty-eight patients with keratoconus (46 with mild and 42 with severe clinical signs) and a control group of 40 normal subjects were included in this study. A decomposition of corneal topography height data into orthogonal Zernike polynomials was performed using the commercially available corneal topographer TMS-1. Expansion coefficients of the different groups were compared to evaluate significant differences. Elevated terms were used to detect the disease. The statistical significance of this detection scheme was compared to those given by the keratoconus detection software of the TMS-1. From the elevated Zernike terms a neural network was constructed and optimized for dividing keratoconus patients and normal controls. RESULTS: Some low-order Zernike coefficients with a radial order n < 8 were found to be elevated in patients with keratoconus and were used to define a new detection algorithm. This index performed at least as well (sensitivity in mild/severe keratoconus 93.4%/100% with a specificity of 100%) as keratoconus detection schemes based on the Klyce-Maeda and the Rabinowitz-Klyce indices as well as the I-S value and the Surface Asymmetry Index SAI in our study population. CONCLUSIONS: Zernike decomposition of corneal topography height data allows a definition of an exact and robust algorithm for detection of keratoconus. It avoids the drawbacks of refractive power based definitions and is independent on the individual topographer design.

Adolescent↗
PubMed2002

The impact of dark adaptation on photoscreening.

PURPOSE: Some previous studies have used different dark adaptation periods to achieve adequate pupil dilation for photo refraction. Because efficient use of time is important in screening programs, we investigated how dark adaptation affects the quality of eye photographs. METHODS: This prospective study was done on 2 groups. In the first group (40 patients), 1 horizontal flash and 1 vertical flash photograph were taken as soon as the room lights were turned off, and a second set of photographs was taken after 10 minutes of dark adaptation. In the second group (37 patients), sets of photographs were taken after 1, 5, and 15 minutes of dark adaptation. Pupillary diameters were measured by an observer who was masked to the timing of the photographs. The findings were compared using the Wilcoxon signed rank test and the Student t test for paired data. RESULTS: Compared with the results at 1 minute, mean pupillary diameter was significantly decreased after 10 minutes of dark adaptation, both with the horizontal (Z = -4.723; P <.001) and the vertical flash (Z = -4.668; P <.001) in the first group. In the second group, the mean pupillary diameters at 1, 5, and 15 minutes in the horizontal flash photos were 5.78 +/- 1.03 mm, 5.35 +/- 1.10 mm, and 5.04 +/- 1.05 mm, respectively, and were 5.70 +/- 0.95 mm, 5.21 +/- 1.09 mm, and 4.86 +/- 0.95 mm, respectively, in the vertical flash photos at these stages. These diameters were all significantly different (P <.001). CONCLUSION: The results indicated that dark adaptation is not a prerequisite for photoscreening, and that, in fact, it might have an adverse effect on pupillary diameter.

Child↗
PubMed1996

Incidence of blindness and visual impairment in diabetic patients participating in an ophthalmological control and screening programme.

We studied the incidence of blindness and visual impairment in patients who were enrolled in a photographic control- and screening program for diabetic retinopathy. The study cohort consisted of 2133 patients examined between January 1990 and December 1992 and followed until October 1st 1995. The occurrence of blindness (visual acuity < or = 0.1) and moderate visual impairment (visual acuity 0.2-0.4) was assessed. The Wisconsin scale was used to grade retinopathy. The mean HbA1c value for the last 8 years was used to represent long-term glycaemic control. Average follow-up time was 2.9 years. Seven patients were blind and 24 had visual impairment caused by retinopathy at the entry of the study. Six patients went blind due to retinopathy during the study period, corresponding to an incidence of 1.0 per 1000 person-years (95% confidence interval 0.4-2.1), and 28 became visually impaired, corresponding to an incidence of 4.6 per 1000 person-years (95% confidence interval 3.0-6.6). Multivariate analysis showed a statistically significant association between blindness/visual impairment and old age, long duration of diabetes, and poor glycaemic control. HbA1c values in the highest quartile, i.e. > or = 8.5%, were associated with a 65% increase in risk of blindness/visual impairment (95% confidence interval 14-130%). Retinopathy was the major cause of blindness and visual impairment in patients with diabetes. The study revealed a low incidence of blindness, which is in line with recent reports. Control of hyperglycaemia may be of value for the prevention of visual loss.

Adolescent↗
PubMed2005

The influence of age, duration of diabetes, cataract, and pupil size on image quality in digital photographic retinal screening.

OBJECTIVE: To evaluate the effect of age, duration of diabetes, cataract, and pupil size on the image quality in digital photographic screening. RESEARCH DESIGN AND METHODS: Randomized groups of 3,650 patients had one-field, non-mydriatic, 45 degrees digital retinal imaging photography before mydriatic two-field photography. A total of 1,549 patients were then examined by an experienced ophthalmologist. Outcome measures were ungradable image rates, age, duration of diabetes, detection of referable diabetic retinopathy, presence of early or obvious central cataract, pupil diameter, and iris color. RESULTS: The ungradable image rate for non-mydriatic photography was 19.7% (95% CI 18.4-21.0) and for mydriatic photography was 3.7% (3.1-4.3). The odds of having one eye ungradable increased by 2.6% (1.6-3.7) for each extra year since diagnosis for nonmydriatic, by 4.1% (2.7-5.7) for mydriatic photography irrespective of age, by 5.8% (5.0-6.7) for non-mydriatic, and by 8.4% (6.5-10.4) for mydriatic photography for every extra year of age, irrespective of years since diagnosis. Obvious central cataract was present in 57% of ungradable mydriatic photographs, early cataract in 21%, no cataract in 9%, and 13% had other pathologies. The pupil diameter in the ungradable eyes showed a significant trend (P < 0.001) in the three groups (obvious cataract 4.434, early cataract 3.379, and no cataract 2.750). CONCLUSIONS: The strongest predictor of ungradable image rates, both for non-mydriatic and mydriatic digital photography, is the age of the person with diabetes. The most common cause of ungradable images was obvious central cataract.

Adult↗
PubMedDate not supplied

Willingness of eye care practices to evaluate children and accept Medicaid.

BACKGROUND: The willingness of eye care providers to evaluate children or to accept Medicaid may be a barrier to care for those with an abnormal screen. OBJECTIVES: To determine the proportion of eye care practices that would provide diagnostic evaluation for children and accept Medicaid payment and to evaluate the influence of child age and practice characteristics on provision of care or acceptance of Medicaid. METHODS: We conducted a telephone survey of 364 eye care practices in Michigan, which were randomly selected from telephone directories of 26 rural and urban cities as defined by metropolitan statistical areas. RESULTS: The response rate was 93%. Most eye care practices, but more optometry-listed practices than ophthalmology-listed ones, would evaluate preschool-aged children (88% vs 73%; P <.01) or school-aged children only (11% vs 7%; P <.01). The proportion of practices willing to evaluate preschool-aged children was lower in urban cities compared with rural cities for optometry-listed (83% vs 96%; P <.01) and ophthalmology-listed practices (67% vs 93%; P <.01). Medicaid acceptance among practices that would evaluate children was higher among ophthalmology-listed than optometry-listed practices (74% vs 59%; P =.01) and did not vary by urban or rural status. Practice size was not associated with willingness to provide care for children. However, among practices that would provide care for children, larger practice size was associated with increased odds of Medicaid acceptance in both optometry-listed and ophthalmology-listed practices. CONCLUSIONS: These findings contradict the perception that eye care for children is unavailable. More work is needed to understand the relationship of this availability with the accessibility of eye care.

Attitude of Health Personnel↗
PubMed1996

Automated suprathreshold static perimetry screening for detecting neuro-ophthalmologic disease.

PURPOSE: To devise and evaluate a rapid, accurate, and cost-effective method of detecting neuro-ophthalmologic visual field defects. METHODS: One hundred fifty-nine consecutive patients were evaluated with 76-point, central 30 degree automated static threshold perimetry on the Humphrey Visual Field Analyzer, as well as by a 76-point, central 30 degree suprathreshold examination with the central reference levels set at 2 or 4 dB lower than the estimated normal median central reference level adjusted for age. Six masked readers reviewed the fields. Their readings were compared with those of the other observers, as well as with the final diagnoses as determined from all available clinical information. RESULTS: In detecting abnormality, the full-threshold 30 degree test had a sensitivity (percent of eyes with true field defects identified by the field test) of 93 percent or 99 percent (depending on whether borderline results were counted as a positive or negative test) and a specificity (percent of cases without true field defects appropriately identified by the field test) of 71 percent or 91 percent. In comparison, the 4-dB offset suprathreshold test had a sensitivity (averaged over all reviewers) of 79 percent or 87 percent and a specificity of 81 percent or 89 percent, whereas the 2-dB test had a sensitivity of 87 percent or 94 percent and a specificity of 73 percent or 85 percent. The mean duration of the suprathreshold tests was 3.5 +/- 1.0 minute, compared with 14.8 +/- 2.8 minutes for the full-threshold technique. CONCLUSION: The central 30 degree, 76-point, 2-dB offset suprathreshold automated perimetry is more rapid and nearly as effective as the full-threshold test in detecting visual field abnormalities due to neuro-ophthalmologic disease. More quantitative, full-threshold perimetric strategies should be used in all equivocal cases and to follow progression of established disease.

Adult↗
PubMed2002

Topography-based screening for previous laser in situ keratomileusis to correct myopia.

PURPOSE: To demonstrate the feasibility of developing a screening tool based on corneal topography to detect previous myopic laser in situ keratomileusis (LASIK). SETTING: Clinical data from a private clinic analyzed in a university setting. METHODS: Two hundred thirty-three topographies were randomly selected so 1 topography per patient was used: 150 from unoperated corneas and 83 from corneas that had LASIK to correct myopia. The mean surgical correction was -4.40 diopters (D) +/- 2.53 (SD) (range -11.00 to -0.38 D). All topographies were performed using an Orbscan II unit (Bausch & Lomb Surgical). The LASIK procedures were performed using a Technolas 217C excimer laser and a Hansatome microkeratome (Bausch & Lomb Surgical). The algorithms used the mean value of the directional derivative (DT) of the anterior tangential curvature of the cornea in the 2.2 mm radius central disk and the mean value of the anterior elevation (E) with respect to the best-fit sphere in the 0.5 mm radius central disk. Topographies in the testing set (n = 119) were classified as operated if E < 0 (E algorithm) or DT > 0 (DT algorithm) or as unoperated. RESULTS: The E algorithm yielded 0% false positives and 16.7% false negatives and the DT algorithm, 6.5% and 7.1%, respectively. For myopia greater than -1.12 D, the DT algorithm provided a 0% false negative rate. The performance of E and DT algorithms, used in combination, was superior to clinical assessment. CONCLUSION: Criteria based on Orbscan II corneal topography are proposed for the detection of previous myopic LASIK performed with a Technolas 217C excimer laser.

Adolescent↗
PubMed1999

Prevalence of diabetic eye disease in an inner city population: the Liverpool Diabetic Eye Study.

PURPOSE: To measure the population prevalence of diabetic eye disease in an inner city setting. METHODS: As part of a systematic screening programme all adult diabetic patients in four general practices were invited to attend for slit-lamp biomicroscopy by a retinal specialist. Data on non-attenders were available from community-based photography. RESULTS: Of 395 diabetic patients identified, 326 attended biomicroscopy with photographic data available on a further 31, giving a 90% compliance rate. Point prevalence of diabetes in the target population was 12.4/ 1000. Demographic data included: mean age 60 years (range 13-92 years); type of control: type I 49, type II insulin-requiring (IR) 40, type II non-insulin-requiring (NIR) 268. Prevalences were as follows: any retinopathy: of all diabetic patients 33.6%, type I 36.7%, type II IR 45.0%, type II NIR 31.3%; proliferative/ advanced: all 1.1%, type I 2.0%, type II IR 0, type II NIR 1.1%; clinically significant macular oedema: all 6.4%, type I 2.3%, type II IR 16.2%, type II NIR 5.7%. The percentage of patients with retinopathy requiring follow-up by an opthalmologist was 4.5%, and 9.2% had macular exudates within 1 disc diameter of fixation or significant circinate maculopathy. Sight-threatening diabetic eye disease (STED) was found in 13.4%. A visual acuity of < or = 6/24 in the better eye occurred in 12 (3.4%) patients and of < or = 6/60 in the better eye in 3 (0.8%). CONCLUSIONS: Compared with previous population studies, prevalences appear to have declined in type I, but remain high in type II diabetic patients and especially in those requiring insulin.

Adolescent↗
PubMed1990

A study of variance in densitometry of retinal nerve fiber layer photographs in normals and glaucoma suspects.

The main object of this research was to develop a reliable method of screening glaucoma suspects and patients for early loss of or changes in the retinal nerve fiber layer (RNFL). This study quantifies the variances due to photography, digitizing, and analysis of red-free photographs of the RNFL. The influence of pupil size, optic disc position and eye movements, film processing, digitizing, and intra- and interphotographic-session and intra- and interoperator variances were established. It was found that pupils needed to be dilated to at least 6 mm, that the optic disc had to be positioned in a standardized area in the negative, that the head of the subject had to remain still during photography, and that film processing and digitizing of the negative needed to be strictly controlled to minimize the variance in collection of densitometry data from RNFL red-free photographs. It was established that focusing of the negatives during digitization was not crucial. Criteria were defined for acceptable negatives. Interphotographic-session and intraoperator variances were not significant in most cases when negatives were digitized to these criteria. Analysis of interphotographic-session variance showed that there were still some factors in photography, film processing, and/or image digitizing that were not sufficiently controlled for long-term follow-up without normalization of the data. Densitometry data gathered using the established protocol, from negatives of 71 subjects were analyzed; best sensitivity and specificity rates of 80% and 100%, respectively, were achieved for the diagnosis of glaucoma.

Adult↗
PubMedDate not supplied

Primary care physicians' practice patterns and diabetic retinopathy. Current levels of care.

BACKGROUND: Diabetic retinopathy is a costly and prevalent complication of diabetes mellitus. OBJECTIVE: To assess primary care physicians' self-reported practice patterns for the screening and detection of diabetic retinopathy relative to published guidelines. PARTICIPANTS AND METHODS: All primary care physicians (defined as general internists, family practitioners, and general practitioners) in Indiana were identified and surveyed using a mailed questionnaire. Of 2390 physicians, 1508 (63%) responded and were determined to be eligible. Of these 1508 physicians, 1058 (70%) completed all or some of the eye care-related questions. For each eye care practice, physicians were asked to specify the proportion of patients to which the practice was applied and the frequency (eg, every 3 months) with which the behavior was performed, if appropriate. Physicians were also asked to distinguish between patients with type I (insulin-dependent) and type II (non-insulin-dependent) diabetes mellitus for each practice behavior. RESULTS: Physicians' responses were classified as "high," "moderate," or "low" based on the American Diabetes Association guidelines. Forty-five percent of the physicians' responses were classified as high for referring all of their patients with type I diabetes mellitus to an eye care specialist annually as were 35% of the physicians' responses for referring their patients with type II diabetes mellitus. Fewer physicians reported high levels of routine in-office funduscopic examination. No relationship was found between the extent to which physicians performed an in-office funduscopic examination and patterns of referral to eye care specialists. Logistic regression analysis suggested that recent graduates and general internists are most likely to report behavior that is considered high (P < .05). CONCLUSION: The diabetic retinopathy-related practice patterns of primary care physicians in Indiana differ significantly from published guidelines.

Diabetes Mellitus, Type 1↗