Medical Policy

Policy Num:      09.003.032
Policy Name:    Fundus Photography and Extended Ophthalmoscopy
Policy ID           [09.003.032]  [Ac / L / M+ / P-]  [0.00.00]

Last Review:    June 3, 2025
Next Review:    October 20, 2025
 

Related Policies:

  09.003.031 Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma

  09.003.001 Corneal Topography/Computer-Assisted Corneal Topography/ Photokeratoscopy

  09.003.013 Retinal Tele-screening for Diabetic Retinopathy

Fundus Photography and Extended Ophthalmoscopy 

Summary

Description

Fundus photography

Fundus photography is the practice of using a retinal camera to record anomalies in the retina and eye-related disease processes so that the progression of the disease can be tracked. The test must be utilized to make medical decisions for the patient.

Extended ophthalmoscopy

Extended ophthalmoscopy is a thorough examination of the retina that always includes a true drawing of the retina, interpretation, and report. It is typically conducted using an indirect lens, although it can also be done with contact lens biomicroscopy. This is often done with the pupil dilated and may need scleral depression. It is performed when a more detailed examination is needed, following routine ophthalmoscopy.

Objective

The objective of this evidence review is to assess the medical necessity of fundus photography and extended ophthalmoscopy.

Policy Statement

Fundus photography

Triple S recocgnize Medical necesity for fundus photography as defined bellow:

• to document abnormalities of disease processes affecting the eye
• to follow the progress or therapeutic response.
• for the diagnosis of conditions such as macular degeneration, retinal neoplasms, choroid disturbances and diabetic retinopathy, glaucoma, multiple sclerosis or other central nervous system anomalies.
• for examination of the retina in diabetic patients, in whom symptoms of visual disturbances may be present and in whom retinal examination may be unremarkable or normal.

Extended ophthalmoscopy

Extended ophthalmoscopy is considered medically necessary when the level of examination requires a complete view of the posterior segment of the eye and documentation is greater than that required for general ophthalmoscopy.

An extended ophthalmoscopy may be considered  medically necessary for the following conditions:

• Malignant neoplasm of the retina or choroid.
   
• Retained (old) intraocular foreign body, either magnetic or nonmagnetic. Signs and symptoms may include a statement by the patient that something has hit his/her eye (foreign body sensation), normal or blurred vision, pain or no discomfort, and tearing.
   
• Retinal hemorrhage, edema, ischemia, exudates and deposits, hereditary retinal dystrophies or peripheral retinal degeneration.
   
• Retinal detachment with or without retinal defect. The patient may complain of light flashes, dark floating specks, and blurred vision that becomes progressively worse. This may be described by the patient as "a curtain came down over my eyes."
   
• Symptoms suggestive of retinal defect (ex: flashes and/or floaters).
   
• Retinal defects without retinal detachment.
   
• Diabetic retinopathy (i.e., background retinopathy or proliferative retinopathy), retinal vascular occlusion, or separation of the retinal layers. This may be evidenced by microaneurysms, cotton wool spots, exudates, hemorrhages, or fibrous proliferation.
   
• Experienced sudden visual loss or transient visual loss.
   
• Chorioretinitis, chorioretinal scars or choroidal degeneration, dystrophies, hemorrhage and rupture, or detachment.
   
• Sustained a penetrating wound to the orbit resulting in the retention of a foreign body in the eye.
   
• Sustained a blunt injury to the eye or pariorbita.
   
• Disorders of the vitreous body (i.e., vitreous hemorrhage or posterior vitreous detachment). Spots before the eyes (floaters) and flashing lights (photopsia) can be signs/symptoms of these disorders.
   
• Posterior scleritis. Signs and symptoms may include severe pain and inflammation, proptosis, limited ocular movements, and a loss of a portion of the visual field.
   
• Vogt-Koyanagi syndrome. A condition characterized by bilateral uveitis, dysacousia, meningeal irritation, whitening of patches of hair (poliosis), vitiligo, and retinal detachment. The disease can be initiated by a severe headache, deep orbital pain, vertigo, and nausea.
   
• Degenerative disorders of the globe.
   
• Retinoschisis and retinal cysts. Patients may complain of light flashes and floaters.
   
• Signs and symptoms of endophthalmitis, which may include severe pain, redness, photophobia, and profound loss of vision.
   
• Glaucoma or is a glaucoma suspect. This may be evidenced by increased intraocular pressure or progressive cupping of the optic nerve.
   
• Systemic disorders which may be associated with retinal pathology.
   
• High axial length myopia
   
• Retinal edema
   
• Metamorphopsia
   
• High-risk medication for retinopathy or optic neuropathy.
   
• Choroidal nevus being evaluated for malignant transformation.
   
• Macular degeneration.

Extended ophthalmoscopy is consider investigational If the study is performed as a screening service.

Policy Guidelines

Fundus photography

• All tests must include a written interpretation.
• Unless the condition is being activelly treated, fundus photography will be considered as medically necessary with a frequency of once a year.  In such cirmscumstances where fundus phorgraphy need to be performed more pften it will be payable to the activelly trating provider. 

Therefore, baseline photos to document a condition that is reasonably expected to be static and/or not require future treatment would not be medically necessary. Such photos to provide a means of comparison to detect, for example, potential progression of diabetic retinopathy, advanced non-neovascular (dry) macular degeneration with “suspicious” areas, or a nevus or other tumor could be medically necessary.

Repeat fundus photography should only be performed at clinically reasonable intervals (i.e., consistent with a noted change on examination or after sufficient time has elapsed for progression or for a treatment to have reasonably had an impact).

Specific to this policy, fundus photography to guide a given treatment or intervention (vs. monitoring for progression) e.g., photos used to guide the placement of macular laser treatment or to monitor the response to intraocular vascular endothelial growth factor (VEGF) agents should only be ordered by the physician who actually performs the treatment or intervention.
 

Extended ophthalmoscopy

• Extended ophthalmoscopy of a fellow eye without signs or symptoms or new abnormalities on general ophthalmoscopic exam will be denied as not medically necessary. Repeated extended ophthalmoscopy at each visit without change in signs, symptoms or condition may be denied as not medically necessary.
• General ophthalmoscopy and biomicroscopy are part of an ophthalmologic examination and are not separately payable, but these should still be documented in the patient's medical record.
• If indirect ophthalmoscopy is done without a drawing or does not meet the standards indicated in this policy, the service is not separately payable and will be considered part of a general ophthalmologic exam or E&M service.
• Extended ophthalmoscopy performed during the global surgery period of an ophthalmologic surgery procedure, by the same provider performing the surgery, will not be separately payable unless unrelated to the condition for which the surgery was performed.
• If the medical record does not include the interpretation and report, the extended ophthalmoscopy will be denied as not medically necessary.
• Extended ophthalmoscopy will be denied as not medically necessary when it is done in lieu of routine ophthalmoscopy unless the indication for this more extensive examination is documented in the medical record.
• When other ophthalmological tests (e.g., fundus photography) have been performed, extended ophthalmoscopy will be denied as not medically necessary unless there was a reasonable medical expectation that the multiple imaging services might provide additive (non-duplicative) information. 

Documentation Requirements

The patient’s medical record should include but is not limited to:

• The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
• Relevant medical history
• Results of pertinent tests/procedures
• Signed and dated office visit record/operative report.

Fundus photography

The patient's medical record must contain documentation that fully supports the medical necessity for fundus photography. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

A copy of the fundus photographs must be retained in the patient's medical records. An interpretation and report of the test must also be included, in addition to the photographs themselves.

The medical record should document whether the pupil was dilated, and which drug was used.

Documentation supporting the medical necessity should be legible, maintained in the patient's record, and must be available upon request.

Extended ophthalmoscopy

The patient's medical record must contain documentation that fully supports the medical necessity for extended ophthalmoscopy for each eye. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Retinal drawings meeting the specifications indicated in the policy must be maintained in the patient's record.

• There must be a separate detailed sketch, minimal size of 3-4 inches.
• All items noted must be identified and labeled.
• Drawings in four (4) - six (6) standard colors are preferred. However, non-colored drawings are also acceptable, if clearly labeled.
• Optic nerve abnormalities should be separately drawn.
• An extensive scaled drawing must accurately represent normal, abnormal and common findings such as: lattice degeneration, hypertensive vascular changes, proliferative diabetic retinopathy, as well as retinal detachments, holes, tears or tumors.

Documentation in the patient’s medical record for a diagnosis of glaucoma must include all of the following:

• A separate detailed drawing of the optic nerve along with an interpretation that affects the plan of treatment,
• Documentation of cupping, disc rim, pallor, and slope,
• Documentation of any surrounding pathology around the optic nerve.

Documentation specific to the method of examination (e.g., lens, scleral depression, instrument used) should be maintained in the medical record.

The medical record should document whether the pupil was dilated, and which drug was used.

All findings and a plan of action should be documented in notes.

Although routine ophthalmoscopy and biomicroscopy are part of an ophthalmologic examination and are not separately payable, these should still be documented in the patient's medical record.

Documentation supporting the medical necessity should be legible, maintained in the patient's record, and must be available upon request.

Patients actively being treated with intravitreal injections of medication for exudative AMD (ICD-10-CM code H35.32) may require up to 12 extended ophthalmoscopies per eye, per year.

Conditions coded with ICD-10-CM codes listed below may require up to six (6) extended ophthalmoscopic examinations per eye, per year.

A18.53, A18.54, E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359, E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359, G45.3, H16.241, H16.242, H16.243, H20.00, H20.011, H20.012, H20.013, H20.021, H20.022, H20.023, H20.031, H20.032, H20.033, H20.41, H20.042, H20.043, H20.11, H20.12, H20.13, H20.21, H20.22, H20.23, H20.811, H20.812, H20.813, H20.821, H20.822, H20.823, H20.9, H21.01, H21.02, H21.03, H21.1X1, H21.1X2, H21.1X3, H21.211, H21.212, H21.213, H21.221, H21.222, H21.223, H21.231, H21.232, H21.233, H21.241, H21.242, H21.423, H21.251, H21.252, H21.253, H21.261, H21.262, H21.263, H21.271, H21.272, H21.273, H21.301, H21.302, H21.303, H21.311, H21.312, H21.313, H21.321, H21.322, H21.323, H21.331, H21.332, H21.333, H21.341, H21.342, H21.343, H21.351, H21.352, H21.353, H21.41, H21.42, H21.43, H21.501, H21.502, H21.503, H21.511, H21.512, H21.513, H21.521, H21.522, H21.523, H21.531, H21.532, H21.533, H21.541, H21.542, H21.543, H21.551, H21.552, H21.553, H21.561, H21.562, H21.563, H21.81, H21.82, H21.89, H21.9, H22, H30.001, H30.002, H30.003, H30.011, H30.012, H30.013, H30.021, H30.022, H30.023, H30.031, H30.032, H30.033, H30.041, H30.042, H30.043, H30.101, H30.102, H30.103, H30.111, H30.112, H30.113, H30.121, H30.122, H30.123, H30.131, H30.132, H30.133, H30.141, H30.142, H30.143, H30.21, H30.22, H30.23, H30.811, H30.812, H30.813, H30.891, H30.892, H30.893, H30.91, H30.92, H30.93, H31.001, H31.002, H31.003, H31.011, H31.012, H31.013, H31.021, H31.022, H31.023, H31.091, H31.092, H31.093, H31.101, H31.102, H31.103, H31.111, H31.112, H31.113, H31.121, H31.122, H31.123, H31.20, H31.21, H31.22, H31.23, H31.301, H31.302, H31.0303, H31.311, H31.312, H31.313, H31.321, H31.322, H31.323, H31.401, H31.402, H31.403, H31.411, H31.412, H31.413, H31.421, H31.422, H31.423, H31.8, H31.9, H32, H33.001, H33.002, H33.003, H33.011, H33.012, H33.013, H33.021, H33.022, H33.023, H33.031, h33.032. H33.033, H33.041, H33.042, H33.043, H33.051, H33.052, H33.053, H33.101, H33.102, H33.103, H33.111, H33.112, H33.113, H33.121, H33.122, H33.123, H33.191, H33.192, H33.193, H33.20, H33.21, H33.22, H33.23, H33.301, H33.302, H33.303, H33.311, H33.312, H33.313, H33.321, H33.322, H33.323, H33.331, H33.332, H33.333, H33.41, H33.42, H33.43, H33.8, H34.01, H34.02, H34.03, H34.11, H34.12, H34.13, H34.211, H34.212, H34.213, H34.231, H34.232, H34.233, H34.811, H34.812, H34.813, H34.821, H34.822, H34.823, H34.831, H34.832, H34.833, H34.9, H35.00, H35.011, H35.012, H35.013, H35.021, H35.022, H35.023, H35.031, H35.032, H35.033, H35.041, H35.042, H35.043, H35.051, H35.052, H35.053, H35.061, H35.062, H35.063, H35.071, H35.072, H35.073, H35.09, H35.111, H35.112, H35.113, H35.121, H35.122, H35.123, H35.131, H35.132, H35.133, H35.141, H35.142, H35.143, H35.151, H35.152, H35.153, H35.161, H35.162, H35.163, H35.21, H35.22, H35.23, H35.30, H35.31, H35.32, H35.33, H35.341, H35.342, H35.343, H35.351, H35.352, H35.353, H35.361, H35.362, H35.363, H35.371, H35.372, H35.373, H35.381, H35.382, H35.383, H35.40, H35.411, H35.412, H35.413, H35.421, H35.422, H35.423, H35.431, H35.432, H35.433, H35.441, H35.442, H35.443, H35.451, H35.452, H35.453, H35.461, H35.462, H35.463, H35.50, H35.51, H35.52, H35.53, H35.54, H35.61, H35.62, H35.63, H35.70, H35.711, H35.712, H35.713, H35.721, H35.722, H35.723, H35.731, H35.732, H35.733, H35.81, H35.82, H35.89, H35.9, H36, H36.811, H36.812, H36.813, H36.821, H36.822, H36.823, H36.89, H40.001, H40.002, H40.003, H40.011, h40.012, H40.013, H40.031, H40.032, H40.033, H40.041, H40.042, H40.043, H40.051, H40.052, H40.053, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.11X1, H40.11X2, H40.11X3, H40.11X4, H40.1211, H40.1213, H40.1214, H40.1221, H40.1222, H40.1223, H40.1224, H40.1231, H40.1232, H40.1233, H40.1234, H40.1311, H40.1312, H40.1313, H40.1314, H40.1321, H40.1322, H40.1323, H40.1324, H40.1331, H40.1332, H40.1333, H40.1334, H40.1411, H40.1412, H40.1413, H40.1414, H40.1421, H40.1422, H40.1423, H40.1424, H40.1431, H40.1432, H40.1433, H40.1434, H40.151, H40.152, H40.153, H40.20X1, H40.20X2, H40.20X3, H40.20X4, H40.211, H40.212, H40.213, H40.2211, H40.2212, H40.2213, H40.2214, H40.2221, H40.2222, H40.2223, H40.2224, H40.2231, H40.2232, H40.2233, H40.2234, H40.231, H40.232, H40.233, H40.241, H40.242, H40.243, H40.31X1, H40.31X2, H40.31X3, H40.31X4, H40.32X1, H40.32X2, H40.32X3, H40.32X4, H40.33X1, H40.33X2, H40.33X3, H40.33X4, H40.41X1, H40.41X2, H40.41X3, h40.41X4, H40.42X1, H40.42X2, H40.42X3, H40.42X4, H40.43X1, H40.43X2, H40.43X3, H40.43X4, H40.51X1, H40.51X2, H40.51X3, H40.51X4, H40.52X1, H40.52X2, H40.52X3, H40.52X4, H40.53X1, H40.53x2, H40.53X3, H40.53X4, H40.61X1, H40.61X2, H40.61X3, H40.61X4, H40.62X1, H40.62X2, H40.62X3, H40.62X4, H40.63X1, H40.63X2, H40.63X3, H40.63X4, H40.811, H40.812, H40.813, H40.821, h40.822, H40.823, H40.831, H40.832, H40.833, H40.89, H40.9, H42, H44.001, H44.002, H44.003, H44.011, H44.012, H44.013, H44.021, H44.022, H44.023, H44.111, H44.112, H44.113, H44.121, H44.122, H44.123, H44.131, H44.132, H44.133, H44.19, H44.21, H44.22, H44.23, H44.30, H44.311, H44.312, H44.313, H44.321, H44.322, H44.323, H44.391, H44.392, H44.393, H44.40, H44.411, H44.412, H44.413, H44.422, H44.423, H44.431, H44.432, H44.433, , H44.441, H44.442, H44.443, H44.50, H44.511, H44.512, H44.513, H44.521, H44.522, H44.523, H44.531, H44.532, H44.533, H44.601, H44.602, H44.603, H44.611, H44.612, H44.613, H44.621, H44.622, H44.623, H44.631, H44.632, H44.633, H44.641, H44.642, H44.643, H44.651, H44.652, H44.653, H44.691, H44.692, H44.693, H44.701, H44.702, H44.703, H44.711, H44.712, H44.713, H44.721, H44.722, H44.723, H44.731, H44.732, H44.733, H44.741, H44.742, H44.743, H44.751, H44.752, H44.753, H44.791, H44.792, H44.793, H44.811, H44.812, H44.813, H44.821, H44.822, H44.823, H44.89, H44.9, Q15.0

For ICD-10-CM codes C69.41-C69.42, C69.21-C69.22, C69.31-C69.32, C79.89, D31.21-D31.22 and D31.31-D31.32, up to four (4) extended ophthalmoscopic examinations may be required per eye, per year.

Other conditions usually require no more than two (2) extended ophthalmoscopic examinations per eye, per year.

Benefit Application

BlueCard/National Account Issues

State or federal mandates (eg, Federal Employee Program) may dictate that certain U.S. Food and Drug Administration approved devices, drugs, or biologics may not be considered investigational, and thus these devices may be assessed only by their medical necessity.

Optic nerve and retinal nerve fiber analysis may be performed by both ophthalmologists and optometrists.

Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. Benefit products or negotiated coverages may have all or some of the services discussed in this medical policy excluded from their coverage.

Background

Fundus Photography

Fundus photography (also called fundography) is the creation of a photograph of the interior surface of the eye, including the retina, optic disc, macula, and posterior pole (i.e. the fundus). Fundus photography is used by optometrists, ophthalmologists, and trained medical professionals for monitoring progression of a disease, diagnosis of a disease (combined with retinal angiography), or in screening programs and epidemiology.

Compared to ophthalmoscopy, fundus photography generally needs a considerably larger instrument, but has the advantage of availing the image to be examined by a specialist at another location and/or time, as well as providing photo documentation for future reference. Modern fundus photographs generally recreate considerably larger areas of the fundus than what can be seen at any one time with handheld ophthalmoscopes. Fundus photography is typically used as a method of documentation and also in determining the progression and treatment.

Extended Ophthalmoscopy

An extended ophthalmoscopy is a meticulous evaluation of the eye with detailed documentation of a severe ophthalmologic problem when photography is not adequate or appropriate. Extended ophthalmoscopy is used for evaluation of tumors of the retina and choroid, retinal tears, detachments, hemorrhages, exudative detachments, and retinal defects without detachment, as well as other ocular defects. The physician is required to create detailed drawings that reveal the extent of the examination and findings, along with an interpretation and report.

Extended ophthalmoscopy is most frequently performed utilizing an indirect lens, although it may be performed using contact lens biomicroscopy. It may require scleral depression and is usually performed with the pupil dilated. It is performed by the physician when a more detailed examination (including that of the periphery) is needed, following routine ophthalmoscopy. Extended ophthalmoscopy is indicated when the level of examination requires a complete view of the posterior segment of the eye and documentation is greater than that required for general ophthalmoscopy.

Rationale

This evidence review was created in August 2024. The most recent literature update was performed through July 24, 2024.

Evidence reviews assess whether a medical test is clinically useful. A useful test provides information to make a clinical management decision that improves the net health outcome. That is, the balance of benefits and harms is better when the test is used to manage the condition than when another test or no test is used to manage the condition.

The first step in assessing a medical test is to formulate the clinical context and purpose of the test. The test must be technically reliable, clinically valid, and clinically useful for that purpose. Evidence reviews assess the evidence on whether a test is clinically valid and clinically useful. Technical reliability is outside the scope of these reviews, and credible information on technical reliability is available from other sources.

Promotion of greater diversity and inclusion in clinical research of historically marginalized groups (e.g., People of Color [African-American, Asian, Black, Latino and Native American]; LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual); Women; and People with Disabilities [Physical and Invisible]) allows policy populations to be more reflective of and findings more applicable to our diverse members. While we also strive to use inclusive language related to these groups in our policies, use of gender-specific nouns (e.g., women, men, sisters, etc.) will continue when reflective of language used in publications describing study populations.

Population Reference No. 1 

Fundus photography

For individuals with a known eye condition with need to track progression. Intervention of interest is fundus photography compared with clinical assessment alone. Relevant outcomes are  test accuracy, symptoms, morbid events, functional outcomes, and medication use. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

Population Reference No. 2

Extended Ophthalmoscopy

For individuals with suspected retinal and/or optic nerve pathology. Intervention of interest is extended ophthalmoscopy compared with clinical assessment alone. Relevant outcomes are  test accuracy, symptoms, morbid events, functional outcomes, and medication use. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

Population Reference No. 3

Extended Ophthalmoscopy

For individuals with Non known or suspected retinal and/or optic nerve pathology. Intervention of interest is extended ophthalmoscopy compared with clinical assessment alone. Relevant outcomes are  test accuracy, symptoms, morbid events, functional outcomes, and medication use. The evidence is insufficient to determine that the technology results in a meaningful improvement in the net health outcome.

SuPplemental Information

N/A 

References

1. CGS Administrators, LLC Local Coverage Determination (LCD) FOR OPHTHALMOLOGY: POSTERIOR SEGMENT IMAGING (EXTENDED OPHTHALMOSCOPY AND FUNDUS PHOTOGRAPHY) (L34399). Accessed July 24, 2024.
2. National Government Services (NGS). Local Coverage Determination (LCD)  OPHTHALMOLOGY: POSTERIOR SEGMENT IMAGING (EXTENDED OPHTHALMOSCOPY AND FUNDUS PHOTOGRAPHY) (L33567) Accessed July 24, 2024.
3. Palmetto GBA. Local Coverage Determination (LCD)  Ophthalmology: Extended Ophthalmoscopy and Fundus Photography (L33467) Accessed July 24, 2024.
4. American Optometric Association. 2004. Care of the Patient with Age-Related Macular Degeneration . Accessed July 24, 2024.
5. American Optometric Association. 2014. Eye Care of the Patient with Diabetes Mellitus . Accessed July 24, 2024.
6. American Optometric Association. 2004. Care of the Patient with Retinal Detachment and Related Peripheral Vitreoretinal Disease . Accessed July 24, 2024.
7. Armaly MF. Optic cup in normal and glaucomatous eyes. Invest Ophth. 1970;9(6):425-429.
8. Bakri SJ, Sculley L, Singh AD. Imaging techniques for uveal melanoma. Int Ophthalmol Clin. 2006;46(1):1-13.
9. Mayfield J. Who cares about the quality of diabetes care? Almost everyone! Clin Diabet. 1998; 16(4):161-167.
10. Singh RP, Young LH. Diagnostic tests for posterior segment inflammation. Int Ophthalmol Clin. 2006;46(2):195-208.
11. Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Co;1992.
12. Duane TD, Tasman W, Jaeger EA. Duane’s Clinical Ophthalmology. Vol 3. Philadelphia, PA:JB Lippincott Co;1993.
13. Ho AC, Guyer DR, Fine SL. Clinical examination of the posterior segment of the eye. Retina-Vitreous Macula. Philadelphia, PA:WB Saunders Co;1999;1:21-28.
14. Jones WL, Reidy RW. Atlas of the Peripheral Ocular Fundus. Butterworth-Heinemann Publishers;1985:1-4.
15. McPhee SJ, Papadakis MA, Tierney LM. Current Medical Diagnosis and Treatment. Stamford CT:Appleton and Lange;1996.
16. Newell FW. Ophthalmology:Principles and Concepts. St. Louis, MO:Mosby;1992.
17. Bresnick GH, Mukaamel DB, Dickinson JC, Cole DR. A screening approach to the surveillance of patients with diabetes for the presence of vision-threatening retinopathy. Ophthalmology. 2000;107:19-24.
18. Hutchinson A, McIntosh A, Peters J, et al. Effectiveness of screening and monitoring tests for diabetic retinopathy – a systemic review. Diabetes Medicine. 2000;17:495-506.
19. Williams GA, Scott IU, Haller JA, et al. Single-field fundus photography for diabetic retinopathy screening. Ophthalmology. 2004;111:1055-1062.

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