Fundus photography is one option. Though it is not that sensitive, it may provide a good idea of the state of the retina.

Visual acuity is always important. Amsler grid is provide.d to pts to notice any metamorphosis. FFA is available in most units and still  is very valuable.

WHEN IS POSSIPLE COLOR TEST, CONTRAST AND AMSLER TEST... I THINK ARE GOOD TEST TO.

DM: for retinal Changes we use the fundus photography as a Corner stone but it will be completed with VA, OCT and angiography as needed.

AMD: Amsler test is simple and cheap but not specific specially for patients with Dry AMD.

ROP: the cheapest way is fundal examination by an experienced pediatric ophthalmologist otherwise wide field fundus photography with RetCam is preferable when you have few such doctors and wide territory ( telescreening). 

OCT

Retinal Disease - Dilated Fundus Photography, Indirect Slit Lamp Vok Lens, VA Snellen test charts, Amsler, Visual Fields Henson Pro 9000, CV test charts and contrast sensitivity.  In hospitals and in practices which have access to the equipment and expertise: gonioscopy, OCT, FFA, EEG, LogMAR VA test charts in addition to techniques available above dependent upon the retinal disorder encountered.

AMD - Amsler, Snellen VA, near test cards.  In hospital any or all of the above as with retinal disease.

RoP - rarely seen in the high street though we are now experiencing management of pxs who have survived RoP and are now managed in the community rather than at hospital.  Here the techniques used will mostly be Snellen VA, Visual fields, CV and stereopsis assessment.

As mentioned earlier, www.peekvision.org might be a feasible option once the mobile phone-based fundus camera adapter is available.

What might also be of interest is what equipment is used by optometrists who do not have access to the sophisticated equipment in the high street stores.  What techniques are used by rural opticians who visit pxs where electricity is not available and whether these techniques are sensitive enough to detect the subtle differences in eye conditions?

There are increasingly battery powered/solar rechargeable hadheld instruments such as the iphone addition for retinal fundoscopy, digital rebound contact tonometer, portable slit lamps etc.  Simple Bjerrum Screen or confrontation testing may give some increasing sensitivity of visual field loss.  Some of this equipment is quite expensive but excellent for mobile optometrists.

We are developing a Tele-OCT. Regional centers send OCT to main hospital. An innovative software analyzes  not-normal profiles and alerts retina specialist submitting the file in his smartphone.

Until very recently all ophthalmologists did a good job just by using binocular ophthalmoscopy. I think the best is to train young ophthalmologist to use this technique and, if you cannot cover your service by ophthalmologists, train nurses or other professionals to use this simple but very effective method. 

Br J Ophthalmol doi:10.1136/bjophthalmol-2015-307341 Clinical science

Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs

S H Lund1,

T Aspelund1,2,

P Kirby3,

G Russell3,

S Einarsson2,

O Palsson2,

E Stefánsson1,2

+ Author Affiliations

1Faculty of Medicine, University of Iceland, Reykjavik, Iceland

2Risk ehf, Reykjavik, Iceland

3Health Intelligence plc, Cambridge, UK

Correspondence to Professor Einar Stefánsson, Department of Ophthalmology, University of Iceland, National University Hospital, 101 Reykjavík 101, Iceland; [email protected]

Received 26 June 2015

Revised 10 August 2015

Accepted 19 August 2015

Published Online First 16 September 2015

Abstract

Objective To validate a mathematical algorithm that calculates risk of diabetic retinopathy progression in a diabetic population with UK staging (R0–3; M1) of diabetic retinopathy. To establish the utility of the algorithm to reduce screening frequency in this cohort, while maintaining safety standards.

Research design and methods The cohort of 9690 diabetic individuals in England, followed for 2 years. The algorithms calculated individual risk for development of preproliferative retinopathy (R2), active proliferative retinopathy (R3A) and diabetic maculopathy (M1) based on clinical data. Screening intervals were determined such that the increase in risk of developing certain stages of retinopathy between screenings was the same for all patients and identical to mean risk in fixed annual screening. Receiver operating characteristic curves were drawn and area under the curve calculated to estimate the prediction capability.

Results The algorithm predicts the occurrence of the given diabetic retinopathy stages with area under the curve =80% for patients with type II diabetes (CI 0.78 to 0.81). Of the cohort 64% is at less than 5% risk of progression to R2, R3A or M1 within 2 years. By applying a 2 year ceiling to the screening interval, patients with type II diabetes are screened on average every 20 months, which is a 40% reduction in frequency compared with annual screening.

Conclusions The algorithm reliably identifies patients at high risk of developing advanced stages of diabetic retinopathy, including preproliferative R2, active proliferative R3A and maculopathy M1. Majority of patients have less than 5% risk of progression between stages within a year and a small high-risk group is identified. Screening visit frequency and presumably costs in a diabetic retinopathy screening system can be reduced by 40% by using a 2 year ceiling. Individualised risk assessment with 2 year ceiling on screening intervals may be a pragmatic next step in diabetic retinopathy screening in UK, in that safety is maximised and cost reduced by about 40%.

Epidemiology

Retina

Clinical Trial

Diagnostic tests/Investigation

Public health

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skilled funduscopy clinicians to use direct and indirect and slit lamps with volk and other lenses, photography, Amsler chart, peripheral & central perimeters. all can be done with well-trained Optometrists