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.
Was this article helpful?