Member States should choose the most appropriate method for detecting or screening for diabetic retinopathy

It is recommended that the following performance characteristics be considered in assessing reliability in detecting and grading the severity of retinopathy:

■ A seven-field photographic standard or a dilated indirect ophthalmoscopic and stereoscopic macular examination by a retina specialist experienced in diabetic retinopathy are the two gold standards. Nevertheless, specific photographic systems have been validated against these standards, with high agreement at similar levels.

■ Use of speciic photographic systems and protocols (three-field photographs read at a reading centre or speciic two-field images graded against a photographic standard by a trained photographer) or an indirect ophthalmoscopic examination though a dilated pupil by an experienced ophthalmologist offer results that are comparable to those of the gold standards.

■ The performance of examinations through a dilated pupil by indirect ophthalmoscopy and stereo-bio-microscopic examination of the macula by an ophthalmologist or an optometrsts is 50-70% that of the gold standards.

■ The performance of other photographic systems, with one or two fields and different equipment parameters, is similar to or better than eye examinations by general ophthalmologists and optometrsts.

■ Without special and continuing education, the performance of prmary health care providers in conducting eye examinations is less than 50% that of the gold standards.

■ There is currently insufficient direct evidence about the performance of non-health care professionals using other systems of detection for diabetic retinopathy (e.g. health care workers in villages using a direct ophthalmoscope and a standardized reference grading card); however, available evidence in other areas of eye care suggests that performance levels comparable to those of general ophthalmologists and optometrists are achievable.

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