A systematic review 1 including 22 cohort studies was abstracted in DARE. Retinal photography under mydriasis appears to have been the most effective test, with the majority of studies reporting levels of sensitivity over 80%. The effectiveness was compromised when the photographs were ungradable. In screening for any sight-threatening retinopathy using such outcomes as pre- proliferative, proliferative, serious, referable or sight threatening, the specificities achieved were higher than 91% and in all cases the sensitivity was lower than the specificity. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity. Ophthalmoscopy alone could be used for opportunistic case finding, but there was considerable variation in the effectiveness of this test.
A systematic review 2 including cohort 7 studies with a total of 998 subjects was abstracted in DARE. Evidence level I studies, comparing single-field fundus photography interpreted by trained readers with the reference standard of stereophotographs of seven fields, reported sensitivities for retinopathy ranging from 61% (specificity 85%) to 90% (specificity 97%) and specificities ranging from 85% (sensitivity 61%) to 97% (sensitivity 85% and 90%). Evidence level II studies, comparing single-field fundus photography interpreted by trained readers with the reference standard of dilated ophthalmoscopy by an ophthalmologist, reported sensitivities for retinopathy ranging from 38% (specificity 96%) to 100% (specificity 75% and 96%) and specificities ranging from 75% (sensitivity 100%) to 100% (sensitivity 82%).
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