Purpose: To investigate the use of a digital non-mydriatic camera for determi ning the ETDRS clinical level of diabetic retinopathy, and to evaluate its use i n a screening setting to appropriately determine the need for referral to an oph thalmologist (ETDRS level ≥35). Methods: A total of 83 patients with diabetes w ere photographed with and without pharmacological pupil dilation at an ophthalmo logy department using a digital non-mydriatic camera, obtaining two sets of fiv e nonstereoscopic, 45 degree field images of each eye. ETDRS seven standard fiel d, 35-mm stereoscopic colour fundus photographs were also obtained. A subgroup of 59 patients was photographed at an optician’s shop using the digital non-my -driatic camera without pupil dilation. Results: There was substantial agreemen t between the clinical level of diabetic retinopathy assessed from the 35-mm ph otographs and the digital images: the ophthalmology department (κ=0.76) with pu pil dilation and (κ=0.66) without pupil dilation, respectively, and at the opti cian’s (κ=0.60 without pupil dilation). With respect to the need for referral to an ophthalmologist, there was almost perfect agreement in the ophthalmology d epartment (κ=0.88) with pupil dilation and (κ=0.84) without pupil dilation, re spectively, and those taken at the optician’s (κ=0.87 without pupil dilation). Conclusion: A digital non-mydri- atic camera may be used in a screening situation to appropriately determine th e need for referral to an ophthalmologist (ETDRS level ≥35).
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