Screening for diabetic retinopathy in primary care with a mobile fundal camera--evaluation of a South African pilot project

S Afr Med J. 2007 Dec;97(12):1284-8.


Background and aims: In South Africa diabetes makes a significant contribution to the burden of disease. Diabetic retinopathy is a leading cause of adult blindness, and screening can reduce the incidence. This project aimed to implement and evaluate a new service for retinal screening that uses a non-mydriatic mobile fundal camera in primary care. This is the first time such a service has been evaluated in an African primary care context.

Methods: The service was implemented as an operational research study at three community health centres and data were collected to evaluate the operational issues, screening, reporting and referral of patients.

Results: Out of 400 patients screened 84% had a significantly reduced visual acuity, 63% had retinopathy (22% severe nonproliferative, 6% proliferative and 15% maculopathy), 2% of eyes could not be screened and 14% of patients required dilatation. Referral was necessary in 27% of cases for cataracts, in 7% for laser treatment and in 4% for other specialist services. Repeat photography was needed in 8% and urgent follow-up in 12%. A SWOT analysis of the pilot project was completed and recommendations were made on how to integrate it into the district health system.

Conclusion: Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician should be able to photograph almost 10,000 patients a year.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / epidemiology
  • Diagnostic Techniques, Ophthalmological / instrumentation*
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Fundus Oculi
  • Humans
  • Incidence
  • Male
  • Mass Screening / instrumentation*
  • Middle Aged
  • Photography / instrumentation*
  • Pilot Projects
  • Primary Health Care / methods*
  • Reproducibility of Results
  • Retina / pathology*
  • South Africa / epidemiology