Non‐mydriatic fundus photography: A viable alternative to fundoscopy for identification of diabetic retinopathy in an Aboriginal population in rural Western Australia?

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Abstract
Purpose: To evaluate the Canon CR5‐45NM non‐mydriatic fundus camera (Canon, Kanagawa, Japan) for identifying retinopathy and the need for laser treatment in a population of Aboriginal patients with diabetes mellitus in rural Western Australia. Methods: Diabetic Aboriginal patients were photographed through undilated pupils using a Canon CR5‐45NM nonmydriatic fundus camera, after which ophthalmoscopy was performed using indirect ophthalmoscopy through dilated pupils. The examining ophthalmologist recorded the presence of retinopathy and the need for laser treatment. A proportion of patients were rephotographed through dilated pupils. Photographs were reviewed by a second ophthalmologist who evaluated the quality of the image, the presence of retinopathy and the need for laser treatment. Results of fundus photographs and ophthalmoscopy were compared. Results: Three hundred and twenty‐eight eyes in 164 Aboriginal patients were examined. The mean patient age was 48.2 years (range 16–81 years) and the mean duration of diabetes was 7.5 years (range 1–35 years). Seventy‐four eyes (22.6%) were diagnosed with retinopathy using combined examination techniques, 44 (59.5%) of which were identified by ophthalmoscopy and 55 (74.3%) by photography. Thirty‐five eyes were deemed to need treatment, 18 (51.4%) of which were identified by ophthalmoscopy and 30 (85.7%) by photography. Kappa coefficient measurement for agreement for presence of retinopathy and need for referral was 0.41 and 0.53, respectively. Photograph quality was significantly improved following pupil dilation. Conclusions: The Canon CR5‐45NM non‐mydriatic fundus camera was relatively good at identifying diabetic retinopathy and could usefully be applied within a screening programme for treatable disease within this population.