In view of the interest in photographic systems, much work has been devoted to specific technical issues (72,75), including the number of photographs needed; the fields to be used if the full seven-field set is not used; whether photographs should be taken through dilated pupils; and who should interpret the photographs.
In 2004, the American Academy of Ophthalmology concluded that, in the United States, single-field photography is adequate for screening for the purpose of detecting diabetic retinopathy but not for management (73) What is 'acceptable' necessarily varies from society to society in relation to the acceptable 'error' or 'miss' rates and the associated costs of achieving specific performance levels. Most studies indicate that performance levels with photographic systems are at least as good as or better than those of examinations by physicians and health care providers other than experienced retina specialists (75). Sufficient evidence therefore exsts that different societies and countres can adopt different technical performance standards and thus use different techniques. Some will want to do everything possible to avoid misclassification and thus use dilated seven-field photography, while others will adopt the seemingly opposite approach of using a single-field photograph through an undilated pupil. These approaches are not, however, contradictory; rather, they reflect choices based on available resources.
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