Pathological regional cerebral blood flow in opiate-dependent patients during withdrawal: a HMPAO-SPECT study

Diabetic retinopathy is one of the most important causes of blindness. Diabetic patients do not attend outpatient clinics with the necessary regularity for an early diagnosis of the most severe forms of retinopathy. A program was planned to compare the efficiency of a 45 degrees non-mydriatic retinal camera with a Polaroid instant film versus biomicroscopy with a 78D lens and reverse image ophthalmoscope (standard method) in the diagnosis of the presence and evolutive degree of retinopathy. In a cross-sectional epidemiologic study a questionnaire was administered to 258 randomly selected diabetic patients, 129 with and 128 without retinopathy. Information was collected of demographics, visual acuity, diabetes and resources used with each method. The eye fundus with the poorest visual acuity was examined to determine the presence and evolution of retinopathy with the two diagnostic methods. The photographic method had an overall sensitivity of 91.1%, a specificity of 89.7% and a level of agreement of 82% with the standard method. A cost-effective analysis revealed a decrease of 35.7% in the cost per true positive case detected with the photographic methods versus the standard method. The 45 degrees non-mydriatic retinal camera had a similar efficiency to the standard method used in our setting for the diagnosis of diabetic retinopathy, which together with a lower cost per patient renders this method advisable for its use in medical settings that usually control for potential ophthalmologic complications resulting from diabetes mellitus.