Screening for diabetic retinopathy: Perceived barriers and patient acceptability of digital scans

• Objective: To determine the acceptability of digital retinal photography among primary care patients with diabetes who were not getting annual eye examinations; to assess the number of gradable digital retinal photographs. • Methods: Patients overdue for screening eye examinations were invited to a free nonmydriatic retinopathy screening in their primary care office using a digital retinal camera. Images were read by a trained ophthalmologist, and results were made available to the participants and their primary care provider. A questionnaire seeking demographic information, barriers to annual ophthalmic examination, patients' perspectives of their disease, concerns about visual health, and opinions toward a digital retinal scan was completed. • Results: Of successful photographs, 98% were gradable. Of the 83 gradable images, 25% had retinopathy, 20% had other eye pathology, and 5% had both. Increased duration of diabetes, history of diabetic retinopathy, poor health perception, and insurance coverage significantly increased the likelihood of finding retinopathy. Patients missing annual examinations due to insurance issues were 4.65 times more likely to have retinopathy than those not (95% confidence interval, 1.18-18.43). Most patients, 93%, felt use of digital retinal cameras for annual retinal examination to be beneficial. • Conclusion: Digital retinal photography without mydriasis by trained office staff is an effective mechanism to examine patients who are in need of diabetic retinopathy screening. The vast majority of patients in our primary care population had gradable retinal photographs.