Red dots near the centre of the fovea on digital retinal photographs in diabetic retinopathy screening

In retinopathy screening, digital retinal photography detects many patients with red dots within one disc diameter (1DD) of the centre of the fovea but little else. Guidelines vary regarding what should be done with these patients. A single case was observed, however, in which such a patient progressed over seven months to well-established exudative maculopathy with clinically significant macula oedema (CSMO) requiring laser treatment. In the wake of this case we aimed to undertake an audit to gauge how common such cases were. We audited 135 consecutive patients who, when attending for eye screening, were found to have red dots within 1DD of the centre of the fovea but little else. Seventy-eight were male and 57 female, median age 58 years (30–86). The red dots were in one eye in 111/135 (82%) and in both eyes in 24/135 (18%). All were offered six month re-screening. In all, 104/135 (77%) attended for re-screening at six months. In 35/104 (34%) the red dots had resolved; in 63/104 (61%) they were still present in one or both eyes. In 6/104 (6%) the retinopathy had progressed such that referral to an ophthalmologist was indicated according to standard European referral criteria— in 5/6 there were hard exudates within 1DD of the centre of the fovea and/or circinate or group of exudates within the macula; in 1/6 there were three large blot haemorrhages near the centre of the fovea. However, at ophthalmological review two to four months later none of these six patients had CSMO and none required laser therapy. It was concluded that there is a 5% chance of patients with red dots near the centre of the fovea developing macula hard exudates in six months; however, most do not develop CSMO during this time span. Although six month review of such patients would be ideal, because of the resource implications to screening services attempting to reach whole populations, 12 month review may be more pragmatic. Copyright © 2007 John Wiley & Sons. Practical Diabetes Int 2007; 24(2): 79–84 Copyright © 2005 John Wiley & Sons, Ltd.