[Fundus screening by medical technicians]

Area of Science:

• Ophthalmology
• Internal Medicine
• Medical Imaging

Background:

• Ocular fundus photography is crucial for detecting ocular and systemic diseases.
• Screening for these conditions in internal medicine departments can improve patient outcomes.
• Nonmydriatic digital fundus photography offers a non-invasive method for retinal examination.

Purpose of the Study:

• To evaluate the efficacy of nonmydriatic digital fundus photography for broad disease screening in an internal medicine setting.
• To assess the performance of a trained medical technician in interpreting fundus photographs.
• To determine the feasibility of integrating ophthalmological screening into internal medicine.

Main Methods:

• A medical technician received 8 weeks of training in operating a nonmydriatic fundus camera and interpreting images.
• The technician and an ophthalmologist independently evaluated fundus photographs from 218 patients using a custom questionnaire.
• Statistical analysis was performed to compare the detection rates and diagnostic accuracy between the technician and the ophthalmologist.

Main Results:

• The fundus camera proved user-friendly, with the technician achieving proficiency after several weeks.
• The medical technician identified 68% of pathological cases, while the ophthalmologist identified 75% (p=0.0003).
• The technician missed 7% of patients and made some faulty diagnoses, highlighting the need for expert oversight.

Conclusions:

• Ophthalmological screening by a trained medical technician using nonmydriatic digital fundus photography is feasible in internal medicine.
• This approach can facilitate the examination of a large patient cohort and uncover previously unrecognized diseases.
• While technicians can perform initial screening, final diagnosis remains the responsibility of ophthalmologists, suggesting a collaborative model.