Assessment of retinopathy in diabetics newly referred to the diabetic clinic

Delay in referral of patients with significant diabetic retinopathy by the diabetic physician to the ophthalmologist may compromise visual outcome. We prospectively audited the ophthalmic assessment of 37 newly referred diabetic patients to the diabetic clinic. Unbeknown to the diabetologist, patients underwent retinal photography with review of photographs by a consultant ophthalmologist and finally another examination with slit-lamp biomicroscopy by an independent ophthalmologist as “gold standard”. Maculopathy present in 12 of 74 eyes was missed on seven occasions by the diabetic physician and on one occasion by photography (p<0.03 McNemar's test; confidence intervals −15.2% −72.3% physicians, 61.5 −99.8% photography). Inaccuracies in visual acuity measurement and inconsistencies in pupil dilation were noted. Retinal photography may provide a superior means for detection of maculopathy in the newly referred diabetic than assessment by the diabetic physician.