The diagnostic accuracy of single- and five-field fundus photography in diabetic retinopathy screening by primary care physicians

PURPOSE: The aim is to evaluate the diagnostic accuracy of digital fundus photography in diabetic retinopathy (DR) screening at a single university hospital. METHODS: This was a cross-sectional hospital-based study. One hundred and ninety-eight diabetic patients were recruited for comprehensive eye examination by two ophthalmologists. Five-field fundus photographs were taken with a digital, nonmydriatic fundus camera, and trained primary care physicians then graded the severity of DR present by single-field 45° and five-field fundus photography. Sensitivity and specificity of DR grading were reported using the findings from the ophthalmologists’ examinations as a gold standard. RESULTS: When fundus photographs of the participants’ 363 eyes were analyzed for the presence of DR, there was substantial agreement between the two primary care physicians, κ = 0.6226 for single-field and 0.6939 for five-field photograph interpretation. The sensitivity and specificity of DR detection with single-field photographs were 70.7% (95% Confidence interval [CI]; 60.2%–79.7%) and 99.3% (95% CI; 97.4%–99.9%), respectively. Sensitivity and specificity for five-field photographs were 84.5% (95% CI; 75.8%–91.1%) and 98.6% (95% CI; 96.5%–99.6%), respectively. The receiver operating characteristic was 0.85 (0.80–0.90) for single-field photographs and 0.92 (0.88–0.95) for five-field photographs. CONCLUSION: The sensitivity and specificity of fundus photographs for DR detection by primary care physicians were acceptable. Single- and five-field digital fundus photography each represent a convenient screening tool with acceptable accuracy.