Proposed criteria for referring diabetic retinopathy

Diabetic retinopathy is a leading preventable cause of blindness in the United States. The primary care nurse practitioner is often confronted with the decision of whether to refer a person with diabetes to an ophthalmologist. Because ophthalmoscopy may be technically difficult with a particular patient, current recommendations are to refer all diabetics. Unfortunately, many studies reveal that this approach is not working. This article defines criteria for the nurse practitioner to determine who is most in need of referral. The tested criteria have a sensitivity of 77 percent and a specificity of 81 percent when compared with ophthalmoscopy. The criteria are based on the results of ophthalmoscopy, duration of diabetes, status of glycemic control, status of achilles tendon reflex, status of serum creatinine, amount of alcohol consumption and the presence of hypertension. Using the criteria is feasible in a clinic or hospital setting. Use of this tool may improve appropriate ophthalmological referral of persons with diabetes.