Screening for diabetic retinopathy in primary care with a mobile fundal camera - evaluation of a South African pilot project

Abstract

Background and aims:
In South Africa diabetes makes a significant contribution to the burden of disease. Diabetic retinopathy is a leading cause of adult blindness and screening can reduce the incidence. This project aimed to implement and evaluate a new service for retinal screening that uses a non-mydriatic mobile fundal camera in primary care. This is the first time this has been evaluated in an African primary care context.

Methods
The service was implemented as an operational research study at three community health centres and data collected to evaluate the operational issues, screening, reporting and referral of patients.

Results
Out of 400 patients screened 84% had a significantly reduced visual acuity, 61% had retinopathy: 22% severe non-proliferative, 6% proliferative and 15% maculopathy. 2% of eyes could not be screened and 14% of patients required dilatation. Referral was necessary in 27% for cataracts, 7% for laser treatment and 4% for other specialist services. Repeat photography was needed in 8% and urgent follow up in 12%. A SWOT analysis of the pilot project was completed and recommendations made on how to integrate it into the district health system.

Conclusion
Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician should be able to photograph almost 10,000 patients a year.