Is Digital Retinal Imaging effective in screening for Diabetic Retinopathy?

[Ron_AKA]

I was diagnosed with diabetes about 23 years ago. I was made aware of the need for an annual eye exam for diabetic retinopathy. I initially started getting an eye exam annually with an ophthalmologist specializing in retina issues. I saw him for several years. He used the dilation drops for the eye exam. While he is a well recognized specialist in our city and is an associate professor at the university, the exam seemed a little on the crude side. Each year he would make a hand sketch of what I believe were the blood vessels in the retina. At one point after several exams with no changes he basically told me that I was wasting my time (and his of course) getting him to do this exam. He recommended using an optometrist, and if the optometrist detected anything to come back and see him.

I did that. Since the beginning this optometrist used a digital imaging process without dilation eye drops. He would show me the image of the eye on a large computer monitor. He saves the images to determine if there are any changes over time. Thankfully he has detected none to date. I keep my blood glucose in very tight control with an A1c of less than 6.0. More recently he has shown me the cloudiness of cataracts on the annual exam, and even more recently shown the shadows of the PVD in each eye, which occurred post surgery. And most recently he has shown what he says is evidence of PCO in one eye. As a result I have an upcoming appointment to get a second opinion on that and the need for YAG later this month.

So finally my question. Is Digital Retinal Imaging without dilation an effective method to screen for diabetic retinopathy? I have no idea what specific technology he is using other than he has been doing it for several years, and the images on the computer monitor look very clear and detailed to me. And frankly more credible than the hand drawings that the retina specialist was doing. He charges an extra $20-25 for this digital image exam, that isn't covered by healthcare. Seems minimal, and well worth the avoidance of the dilation drops.

[John C Hagan III, MD, FACS, FAAO]

In my opinion this is NOT proper care.  I believe every diabetic needs a dilated exam every year. The back of the eye camera is mainly for use by general practitioners, internists and non-ophthalmologists. I would strongly suggest you see a general/comprehensive ophthalmologist. Retina surgeons are not good for full, regular annual exams, many don't do glasses tests. There is a test that should be done every year when you have your eyes dilated and that is called an OCT (ocular computed tomography) If you have had DM 23 years it would be unusual not to have at least some background diabetic retinopathy.  Get in to see a ophthalmologist Eye MD soon.

[Ron_AKA]

That is something to consider. In the past 3 years I have had 4 different dilated eye exams, including the OCT as part of my screening for cataract surgery and subsequent laser surgery. At one point I had so many exams that I asked the cataract surgeon if I need to do my annual eye exam for diabetic retinopathy as well and he said no. So, I am not really concerned that I currently have issues, unless they are caused by an excessive number of dilated eye exams.

Going forward I will have to figure out how I can get OCT exams. With our health system in Canada I probably will need a referral to get in to see an ophthalmologist that does them.

[MrPresley]

Where I live (Tejas) my optometrist has an OCT scanner. I had my very first one done there in 2015, and since have had them done by my ophthalmologist/retinal specialist along with a full dilated exam twice a year.

[John C Hagan III, MD, FACS, FAAO]

dilated eye exams do not damage the eye, the sole exception being an eye with abnormally narrow anterior segment, in which case dilating can cause angle closure glaucoma

[Ron_AKA]

I did a quick google search to find what my options for a thorough diabetic eye exam might be in Edmonton, Canada. This was the top hit at the link below, and clinic seems to check the boxes for equipment they have. They have Optomap ultra-widefield digital imaging, and a Nidek 3000 OCT 3D retinal imaging system, and say the right things about digital imaging not enough and they do dilated pupil exams. They are optometrists, not ophthalmologists, but I have a feeling that is our system in Alberta. The optometrists do the screening, and then refer you to an ophthalmologist if they detect any concerns.

https://heliooptometry.ca/blog/diabetic-eye-exams-in-edmonton

Their lead optometrist graduated at the same university as I did (points for that!), and did his optometry post grad degree at Pacific University College of Optometry.

Will do a little more checking around to see if there are any better options, and will book my next routine eye exam at this clinic, or another if I find a better one.

[Ron_AKA]

On a more thorough search I found a clinic that uses the Zeiss Cirrus 5000 OCT instead of the Nidek 3000. Do you know if there is any significant difference for the purposes of diabetic retinopathy screening? From memory the Cirrus 5000 is what the surgeon that did my cataracts uses.

[John C Hagan III, MD, FACS, FAAO]

They are all fine OCT instruments.

[Ron_AKA]

Thank you. I will book at the first clinic that I found. I like what they say about diabetic retinopathy screening better.

[John C Hagan III, MD, FACS, FAAO]

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