What's more accurate-retinal screening or opthalmologist?

[goji]

Hi

I had retinal screening done a couple of months ago and got called for an appointment as the screening showed R2 pre-proliferative retinopathy in one eye (the other eye was perfect).

I had my appointment with the opthalmologist and he said he doesn't know why they sent me, that there is some very minor changes (background retinopathy) but nothing to worry about and not grade R2. He's given me a follow-up for 6 months time just to be sure.

I just wonder, which process is more accurate? The digital pics they take blow the surface of the eye up a lot bigger than an opthalmologist would be able to see. For the digital image, I didn't have drops but for the opthalmologist appointment I did have drops - I wonder if this could affect things? I can't see how there can be something on the pics that would just disappear.

Anyone have any thoughts about the relative accuracy of the human eye vs. digital screening?

Thanks
Goji

 

[kegstore]

The retinal screening service are probably just being extra cautious and referring anything they view as "suspect". I'd probably believe the opthalmologist more, however my optician gets some very nice gadgets in, normally 2-3 years ahead of the eye hospital I attend. Her latest toy takes a 3D picture of the retina without the need for dilating drops, and results in a better quality image than I've ever seen the eye hospital obtain with their prehistoric (relatively) kit. You can then manipulate the image on screen, very clever stuff...

 

[cugila]

It isn't a case of accuracy at all. The Retinal Screening is just that, screening. The Optician saw something which he/she was concerned about. So you were rightly referred to a Specialist, the Opthamologist.

He/she would then view the screening pics and also examine you as well. Using the details and the result of the examination you would then get an opinion as to what action is required. In this instance the Specialist decided you weren't as bad as thought, but has still decided to check you out later in the year. So I wouldn't say there is any discrepancy here at all. The system is working and is looking after you.

Just seen kegstores post and agree.

 

[goji]

Hi

Thanks for your responses.

Retinal screening images are done with the hi-tech cameras and the digital images are surveyed by a consultant opthalmologist (eye specialist) - if something shows up then you are referred to an opthalmologist for manual (ie. by human eye) check of the retina.

Cugila there is a discrepancy as the retinal screening consultant rated my image as R2 whereas the consultant who looked in my eyes (with his own eyes) said there was no such thing. Both checks involved a consultant opthalmologist - that's why I'm wondering is the digital image more accurate than the human eye?

Goji

 

[cugila]

As one who has had retinal screening done many times I would say that the Digital Imaging has to be more accurate than someone just looking into your eyes. Was any equipment used ? I certainly wouldn't be happy with such a casual approach to any diagnosis. That is my considered opinion, for what it's worth ! :wink:

 

[cyrryan]

Hi
I am 40 and was at appointment with my opthalmologist this week. Previous to this she had to insert a prism in my glasses due to double vision. The prism worked for me but I felt very low in that this happened to me!
This week I went back to eye clinic at hospital and had drops inserted in both my eyes. The result identified some changes at back of eye. The doctor said and I quote " I may need laser eye surgery but not yet as she wants to see if it heals itself, she did not want to burn other area of eye" I was shocked and depressed to hear this news as I am now so scared of going blind. This would end my life I don't know what to say or do. The doctor really scared me. I take good care of my diabetes as I am type 1. I take Novorapid three times daily and Lantus twice daily. I realise my sugars are not the best at times but I am in control!

Can anyone help, Please???
Cheers
Caoireall.

 

[cugila]

Hi Caoireall.

Don't know if you have rtead this post of mine from way back. It is not about low carbing, what it is about is 'reducing' carbs and it's benefits. Basically getting control of those blood sugar numbers is what you must do and then, maybe some of the problems with your eyesight can improve as mine did. Hope it helps.

Here is the link:
viewtopic.php?f=18&t=9353&start=0&hilit=vision

 

[IanS]

As one who has had retinal screening done many times I would say that the Digital Imaging has to be more accurate than someone just looking into your eyes. Was any equipment used ? I certainly wouldn't be happy with such a casual approach to any diagnosis. That is my considered opinion, for what it's worth ! :wink:

I have to disagree with you there. The retinopathy screening is carried out by someone trained to do little more than take a photograph of the retina (presumably a cheap way of carrying out the screening). The pictures themselves are looked at by an opthalmologist separately for anything worth getting excited about. If there is anything of note, then the patient is refered to an opthalmologist for a look with proper equipment. Using the proper equipment, an opthalmologist can get a good look at the eye in 3 dimensions (the photo is only 2D). In this manner, the opthalmologist can spot problems that the retinopathy screen may miss. Equally the opthalmologist may determine that something that was thrown up on the retinopathy screen is not the problem that was first thought.

The retinopathy screen is just that. A screen to check for conditions that require a proper diagnosis.

In my case an opthalmologist determined that I had glaucoma, but the retinopathy screen would never have picked that up at the stage it was.

IanS

 

[cugila]

We shall have to agree to differ then.......

 

[phoenix]

Caoireall
People with type 1 can develop background retinopathy, even with relatively good control. After 20 years nearly all people with type 1 have some background changes. Better screening also reveals quite small changes. Fortunately today if the condition does progress laser treatments work very well.
This is a good link which descibes pre/non proliferative retinopathy and the steps you can take to delay/prevent progression.Both blood glucose control and blood pressure control are important. However if a person's blood glucose levels are on the high side, it is not a good idea to reduce them too quickly. The chart and link (click on the word, 'sudden improvement') explain why.
[url=http://medweb.bham.ac.uk/easd...dweb.bham.ac.uk/easdec/pre-proliferative.html[/url

 

[TheTartanPimpernel]

There is perhaps more to examining digital images obtained by computer screening than simple observation by 'untrained' operators. It would appear that software algorithms are available which will detect potential problems from a single image. Once more than one digital image is available for examination software can also be used to highlight changes between two or more images of the same eye taken at different time points.

I surmise that the screening process has more to do with eliminating those without problems that might require intervention thus releasing the highly trained resources to concentrate on individuals where potential problems have been identified. Have a rake on the web:-

2.1 Automatic methods

As mentioned previously, the diagnosis of diabetic retinopathy can be divided into the
following two categories:

1. Screening of the diabetic retinopathy
2. Monitoring of the diabetic retinopathy

Most automatic systems approach the detection directly using shape, color, and domain
knowledge of diabetic retinopathy findings, but the abnormalities can also be found indirectly
by detecting changes between two fundus images taken from the same eye
in different time moment [8, 14]. The direct approach contributes to screening of the
disease, where indirect approach contributes to both screening and monitoring of the
diabetic retinopathy. Both approaches use roughly the following stages for finding abnormalities
in fundus images: 1) image enhancement 2) candidate diabetic retinopathy
finding detection 3) classification to correct diabetic retinopathy category (or hypothesis
rejection).

Some of the main features distinguishing between the different findings and normal
fundus parts are the color and brightness. The same features have been verified also by
ophthalmologists

 

[IanS]

We shall have to agree to differ then.......

In my defence, I would point out that my opthalmologist is one of the leading authorities on diabetic eye conditions. :mrgreen:

IanS

 

[ShyGirl]

Re: What's more accurate-retinal screening or opthalmologist

 

[IanS]

... i'd love to be rich enough to go private.

So would I. My other half works for a company where they have a scheme where they cover private medicine for absurdly affordable rates. My own company does as well, but the rates or nowere nearly as absurd.

IanS

 

[FordPrefect]

Well private isnt all that at times. Its a lot more hassle arranging it and getting information between docs and specialists etc also unless you live in a big city its likely you will have to travel further. Also with insurance they normally get funny about "onging" routine treatment for a chronic illness such as diabetes which means you can see a specialist for a while but then it becomes a bit of a battle.

 

[IanS]

There was one insurance company that made the headlines a number of years ago when it was found that they had an exclusion clause for chronic conditions*. They were all the more in the headlines when it was further found that their definition of a chronic condition was anything that they decided was chronic.

Decent private healthcare policies should cover ongoing conditions because that is what they have contracted to do. I am not actually having any part of my diabetes treated privately. Although I was refered to a diabetic opthalmologist, he found galucoma which is not diabetes related. My insurance company are going to have to pick up the bill for ongoing treatment (for the rest of my life) and have given no indication of imposing any limitations. I have yet to find out if my GP will repeat prescribe the medication (especially as it is ~£20 a month).

IanS

* OK, I'll name and shame: Cornhill (now trading as Aliantz) - though they aren't exactly one of the market leaders in this field.