Doctors Can Improve Eye Exams for Diabetic Retinopathy

---

Gill JM, Cole DM, Lebowitz HM, et al.: Accuracy of screening for diabetic retinopathy by family physicians. Ann Fam Med 2:218-220, 2004.

What is the problem and what is known about it so far?

Retinopathy is one of the most common eye problems for people with diabetes. Retinopathy is a disease of the small blood vessels in the retina (a part of a person's eye).

All people with diabetes should be checked for retinopathy on a regular basis. Most adults with diabetes are not checked for retinopathy.

Most people with diabetes get their care from family physicians. These physicians may not have the equipment or may not be trained in screening for diabetic retinopathy.

Who was studied?

Researchers chose 11 family physicians. They examined 28 patients with diabetes.

How was the study done?

Researchers picked 28 patients of a local ophthalmologist (eye doctor). These patients had eye problems ranging from no disease to severe retinopathy.

The family physicians first went through a 4-hour training program. They learned how to check for problems in the retina. They also learned how to use a new kind of tool (scope) that gives a better view of the eyes than standard scopes.

In training, the physicians examined seven patients with diabetic retinopathy. The physicians decided whether each patient needed a referral to an eye specialist.

Four weeks later, the family physicians returned. Each physician did an eye exam on each of the 28 study patients. Using what they learned in training, physicians made the decision whether to refer patients to eye specialists.

The eye doctor that trained the family physicians also examined the patients.

What did the researchers find?

Of the patients examined, 75% needed to be referred to a specialist. In general, the family physicians referred 76% to a specialist.

These physicians were more accurate in making referrals than family physicians who hadn't been specially trained.

What were the limitations of the study?

The physicians had only one training workshop. They only had 1 month of practice with the new methods and equipment. They would likely grow even more accurate with more time and practice.

The study group was small. The physicians all volunteered to be in the study. Future studies could include a larger group of physicians chosen at random.

What are the implications of the study?

All patients with diabetes should be examined by an eye specialist. Unfortunately, some patients with diabetes are never seen by an eye specialist. Family physicians who can better screen for diabetic retinopathy may be able to motivate patients to see a specialist.