Photography combined with ophthalmoscopy in retinal screening

To assess a 4mm pupil camera (Canon CR3 45NM “non‐mydriatic” retinal camera) Polaroid photography combined with diabetic clinic ophthalmoscopy, 137 annual‐review patients not already under an ophthalmologist were randomly assigned to: ophthalmoscopy with mydriatic (Group 1); retinal photography with mydriatic only if required (Group 2); retinal photography with mydriatic (Group 3). Ophthalmoscopy was undertaken in all Group 3 patients but in only Group 2 patients with retinopathy on the Polaroid. They were graded for quality. Groups 2 and 3 achieved similar diabetic retinopathy detection and good‐quality photograph rates. Clinic doctors reported diabetic retinopathy in 9/41 (22%) Group 1 and 26/96 (27%) in Groups 2 and 3. Review of the Polaroids by an experienced observer revealed a further seven patients with probable retinopathy. This review also identified four patients warranting an ophthalmologist's opinion (three required laser therapy). More diabetic retinopathy was detected with ophthalmoscopy and photography than with ophthalmoscopy alone. It is only necessary to dilate about 17% of eyes to obtain >90% good quality Polaroids and may not be necessary to use ophthalmoscopy if there is definitely no retinopathy on good quality photographs. The photograph allows senior members of the team to review the fundi of patients seen by juniors and discussion with an ophthalmologist without the patient being present, the ophthalmologist choosing whom to see further.