The value of early detection of retinopathy through dilated retinal exams has been well established in peer reviewed analysis toward reducing morbidities of vision loss and reducing cost of care. Yearly retinal exams in diabetic patients and biannual exams in patients with established retinal disease are established practice patterns by the American Academy of Ophthalmology and the American Medical Association. Similarly, screening of elderly patients for the presence of age related macular degeneration, glaucoma and medication toxicity is highly efficacious in preserving vision. When patients question the necessity of these exams, I usually respond that "it’s what you don't know that may hurt you most."
The use of single field fundus photography as a screening tool has proven highly effective in detecting retinal disorders and generating referrals for further ophthalmic management. Emerging technologies such as smart phone fundus imaging may make these types of screening even more convenient. The use of these technologies alone rather than as a pre-screening tool may however result in under diagnosis of other ocular disorders. Meta-analysis of digital fundus imaging as early detection of disease confirms that fundus photography alone is not as effective to early detection of disease as clinical ophthalmoscopy.
In the diabetic patient, co morbidities for glaucoma, cataract and macular degeneration may be overlooked at least at the early detection phase of the disease. Visual symptoms associated with hyperglycemia, cortical vision loss or ocular motility disorders might also be misinterpreted without clinical correlation. Hypertensive disorders or venous stasis from blood dyscrasias can be mistaken for diabetic retinopathy.
High cost neuro imaging studies and systemic work ups can sometimes be avoided or better tailored with the guidance of a simple clinical exam. A yearly dilated fundus exam by an ophthalmologist is still the gold standard for the early diagnosis and management of retinal disease.
Contributed by: Michael J. Clune, MD, with Eastside Eye Physicians with practices in St. Clair Shores and Shelby Township. Dr. Clune has published work on the management of diabetic retinopathy, glaucoma surgery and photorefractive keratectomy. He has been the Section Chief of Ophthalmology at St. John Providence Medical Center since 2005. Dr. Clune has been recognized as a “Top Doc” on multiple occasions by Hour Detroit Magazine. Specialty areas: cataract surgery, LASIK/refractive surgery
Dr. Clune is a member of The Physician Alliance, a physician organization representing more than 2,200 primary care and specialty physicians in southeast Michigan.
This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.