Eye Photo is a non-profit retinal photography service operated by the MSO to help primary physicians screen their patients for diabetic retinopathy.

An annual retinal examination to screen for diabetic retinopathy is a standard of care in diabetes mellitus. See "Why Screen for Diabetic Retinopathy?" [Watch video: Screening for diabetic retinopathy]. This examination may be carried out by the primary physician using direct ophthalmoscopy or by referral to a specialist eye clinic. If the primary physician is unable to do the screening, or if the patient does not wish to be referred to an ophthalmologist, community-based retinal photography is an option that is effective and efficient. See Retinal Photography for Diabetic Retinopathy Screening.

Our role

Eye Photo is a photography service that is operated by non-medical staff. We take high-resolution retinal photographs for patients that primary physicians may use to look for signs of sight-threatening diabetic retinopathy.

Normal fundus

Sight-threatening diabetic maculopathy

We do not give reports, provide medical advice, comment on patient care, endorse or sell any products, give recommendations for eye specialist referrals or retain patient data/records.

Our target population is the diabetic community that is currently under-screened owing to lack of awareness, lack of access to other means of screening, or both. It is not our aim to replace any existing medical eye care that patients may already be receiving.

Important note:
Retinal photography for diabetic retinopathy screening is purpose-specific, and cannot be relied on to exclude the presence of coexisting eye conditions, such as glaucoma or macular disorders. Hence, patients who desire a comprehensive eye evaluation should be advised to see an ophthalmologist, instead of undergoing retinal photography alone.

Please note also that some patients may not be suitable for retinal photography if they have small pupils or significant opacities in their ocular media. See Before Sending a Patient.

Interpreting the retinal photographs

Interpretation of the retinal photographs is done by the referring physician. See How to grade diabetic retinopathy. The MSO also conducts Diabetic Retinopathy Grading Workshops to help primary physicians to do this more confidently. See More resources – workshops and reference materials.

The physician then decides on the appropriate next course of action based on the findings. See Screening schedule and flow chart.

Operating Hours

Mondays to Friday: 8am - 5pm
Saturday: 9am - 1pm
Closed on Saturdays, Sundays and public holidays.

Location Map and Contact Information

	Klinik Kesihatan Jeram, 45800 Jeram, Selangor, Malaysia.
	Klinik Kesihatan Jeram, 45800 Jeram, Selangor, Malaysia.
	03-3264 0720
	Mondays to Fridays: 8am-5pm Sat, Sun and public holidays CLOSED.

Malaysian Society of Ophthalmology, Unit #UG33, PJ Midtown, Jalan Kemajuan, Seksyen 13, 46200 Petaling Jaya, Selangor, Malaysia. [ Contact Us ]

Recommended Screening Schedule ²

² Adapted from the CPG for the Screening of Diabetic Retinopathy, MOH, 2011
* Shorter follow up intervals are needed in presence of visual symptoms, diabetic retinopathy, poor glycaemic control or comorbid conditions.

Flow Chart ¹

¹ Adapted from “Algorithm for Sceening of Diabetic Retinopathy to Prevent Blindness” in CPG for the Screening of Diabetic Retinopathy, MOH, 2011
Testing visual acuity

Using the MSO Diabetic Eye Photo Service

1. Referring the patient
	The primary doctor sends the patient with a referral note (preferred). Appointments are not necessary - the patient may walk in during opening hours.
2. At Eye Photo - taking the photographs
	Photographs of the central retinal fields are taken without prior pupil dilation and the images are given to the patient on postcard sized prints. This is free and patients do not need to pay. If photographs of reasonable quality cannot be obtained (owing to small pupils or media opacity), no prints will be given and the patient will be advised to see his or her doctor for further advice.
3. Reading the photographs
	The patient brings the images back to the referring physician. The physician interprets the images and advises the patient accordingly. The physician may contact Eye Photo if he or she would like any help or clarification in reviewing the retinal photographs.

Grading of retinal photographs for clinical decision-making

References:

1. CPG for the Screening of Diabetic Retinopathy, June 2011, MOH/P/PAK/216.11(GU)
2. Preferred Practice Pattern on Diabetic Retinopathy 2008, American Academy of Ophthalmology

Not all eyes are amenable to obtaining good quality retinal photographs. Adequate photography may not be possible with:

• small pupils of <3.5 mm in dim light
• significant media opacity from, for instance, cataracts and vitreous haemorrhage.

A quick and easy way to check for this is by doing a red reflex test. 

Good pupil size and a good red reflex - photos likely to be good

»»» «««

Absent red reflex from significant media opacity - a good photo will not be possible

In such situations, a direct referral to an eye clinic is the preferable option, to spare the patient an unproductive trip for retinal photography.

With the rising prevalence of diabetes mellitus worldwide, diabetic retinopathy is now a leading cause of blindness among working age individuals.

Prevalence of diabetes mellitus in Malaysia (>30 years age group)
(Data from the National Health and Morbidity Surveys)

Diabetic vision loss can be prevented by early detection and treatment of sight-threatening diabetic retinopathy.

Because the most effective window period for treatment is usually at a time when the patient is still asymptomatic, clinical practice guidelines worldwide call for routine annual eye screening for all diabetic persons so that those at risk of visual loss may be identified and treated (*Diabetic Retinopathy Screening CPG, KKM 2008).

Failure to screen is a major reason why many diabetic patients present to the ophthalmologist with established visual loss that could have been prevented with timely intervention.

The retina may be viewed non-invasively in the general practice setting by using a direct ophthalmoscope. However, this technique requires training and has inherent limitations, in that it affords a relatively small field of view and is dependent on pupil size.

The retina may also be visualized by fundus (retinal) photography. As an effective and efficient method for high volume screening, it is now used by many health systems worldwide as a screening tool for diabetic retinopathy. Studies have shown that non-mydriatic (with undilated pupils) photography has equal or better sensitivity and specificity when compared to direct ophthalmoscopy for this purpose.

Reproduced from the CPG for the Screening of Diabetic Retinopathy, MOH, 2011

Videos

• Why screen for Diabetic Retinopathy? 
• Testing for visual acuity 
• Testing the red eye reflex 

Printable Brochures

• Eye Photo brochure [ Download ]
• “A quick guide to reviewing diabetic retinal photographs” reference card [ Download ]

References (External Links)

CPG for Screening of diabetic retinopathy (Malaysia)