Does direct ophthalmoscopy improve retinal screening for diabetic eye disease by retinal photography?
Does direct ophthalmoscopy improve retinal screening for diabetic eye disease by retinal photography?
复制标题
DOI：
10.1046/j.1464-5491.2002.00800.x
复制
发表时间：
2002-10-01
影响因子：
3.5
通讯作者：
Ellingford, A
中科院分区：
文献类型：
--
作者：
Leese, GP;Ellis, JD;Ellingford, A
目的 确定在进行视网膜照相后，直接检眼镜检查是否可以提高筛查威胁视力的糖尿病眼病 (STDED) 的检出率。 方法 纳入之前在 3 个月内接受过由糖尿病科医生进行的散瞳直接检眼镜检查和由糖尿病科医生分级的视网膜照相的患者 (n = 408)。分级者/筛选者无法获得其他筛选方式的结果。前 308 名患者是诊所的连续就诊者，符合研究标准，其中 100 名患者被选中，因为他们被其中任何一种方式确定为潜在的 STDED。然后，眼科医生使用裂隙灯生物显微镜检查了患有潜在 STDED 的患者。结果 在 357 名 (88%) 患者中，两种方式对于是否需要转诊至眼科医生达成了一致 (kappa 0.62)。视网膜摄影确定了 38 名转诊至眼科但检眼镜检查未发现的患者。其中，眼科医生一致认为 32 名患者 (84%) 存在 STDED，其中 4 名患者需要早期激光治疗。检眼镜确定了 13 名未通过照片识别的患者进行转诊。其中，眼科医生同意糖尿病专家的观点，即 7 名患者 (54%) 存在 STDED，其中 1 名患者需要早期激光治疗。结论 眼底镜检查可以识别偶尔患有 STDED 的糖尿病患者，而视网膜摄影可能漏掉这种情况。对于系统性视网膜筛查计划，在视网膜摄影中添加检眼镜检查会增加假阳性转诊，并且可能只会检测到少数需要激光的额外患者。
Aims To identify whether after performing retinal photography, direct ophthalmoscopy can improve the yield of screening for the detection of sight-threatening diabetic eye disease (STDED).Methods Patients (n = 408) who had previously received both dilated direct ophthalmoscopy by a diabetologist and retinal photography graded by a diabetologist within 3 months of each other were included. The results of the other screening modality were not available to the grader/screener. The first 308 patients were consecutive attendees at the clinic who fulfilled the study criteria and 100 were selected because they were identified as having potential STDED by either one of these modalities. An ophthalmologist using slit lamp biomicroscopy then examined patients identified with potential STDED.Results In 357 (88%) patients there was agreement between the two modalities about whether referral to an ophthalmologist was required (kappa 0.62). Retinal photography identified 38 patients for referral to ophthalmology which ophthalmoscopy missed. Of these, the ophthalmologist agreed that STDED was present in 32 (84%) and four patients required early laser. Ophthalmoscopy identified 13 patients for referral who were not identified by photography. Of these, the ophthalmologist agreed with the diabetologist that STDED was present in seven (54%) and one patient required early laser.Conclusion Ophthalmoscopy may identify the occasional patient with diabetes who has STDED which is missed by retinal photography. For a systematic retinal screening programme, adding ophthalmoscopy to retinal photography will increase false-positive referrals and is likely to detect only a few extra patients requiring laser.