Dr.Rengaraj Venkatesh
Purpose:
Determine if routine fundus photography increases detection of posterior segment disease (PSD) in a community setting.
Methods:
Stepped-wedge, cluster-randomized trial of 1990 patients presenting for tele-consultation at 4 community eye clinics at the Aravind Eye Care System in Pondicherry, India. Clinics were randomized to optional (control) or routine fundus photography. The proportion of patients with any PSD, referral-warranted PSD, and sight-threatening disease was compared across groups.
Results:
Compared to controls (N=853), patients undergoing routine fundus photography (N=1137) had higher percentages of PSD (94 vs. 91%), referral-warranted PSD (40% vs. 29%), and referral-warranted PSD specifically found on photography (30% vs. 15%). Both groups had similar percentages of sight-threatening disease among those referred (9-10%), while patients undergoing routine fundus photography had higher percentage of any sight-threatening disease detected (3.7% vs. 3.0%).
Conclusion:
Routine fundus photography in the community setting significantly increases detection of referral-warranted disease, but only slightly increases detection of immediately sight-threatening disease.
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