Improved detection and referral of patients with diabetic retinopathy by primary care physicians. Effectiveness of education.

We studied the effect of a 4-hour course in recognition and management of diabetic retinopathy on the ability of nonophthalmologist physicians to detect and to appropriately refer patients with sight-threatening diabetic retinopathy. Participants completed a written examination covering case management and performed a total of 340 dilated ophthalmoscopic examinations on selected patients before and 2 weeks following the teaching session. Accuracy of ophthalmoscopy was assessed by comparison with standardized grading of fundus photographs. Scores on the written examination increased from a mean of 49% to 78% correct. The likelihood of failing to detect and appropriately refer patients with proliferative or preproliferative retinopathy decreased from 60% to 15%. Similarly, for patients with maculopathy, the likelihood of failure to detect and to appropriately refer decreased from 83% to 15.6%. These data suggest that education may significantly improve the ability of nonophthalmologists to detect and to appropriately refer patients who are at risk for vision loss.