Web-based screening for diabetic retinopathy in a primary care population: The EyeCheck project
Web-based screening for diabetic retinopathy in a primary care population: The EyeCheck project
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DOI：
10.1089/tmj.2005.11.668
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发表时间：
2005-12-01
期刊：
影响因子：
--
通讯作者：
Suttorp-Schulten, MSA
中科院分区：
文献类型：
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作者：
Abramoff, MD;Suttorp-Schulten, MSA
本研究的目的是评估在荷兰初级保健人群中采用基于网络的ATA 2类筛查糖尿病视网膜病变的可行性。在2003年1月1日至12月31日期间，共有1676名在初级保健机构就诊的糖尿病患者，没有已知的糖尿病视网膜病变，也没有眼科医生进行过筛查。患者接受了简短的问卷调查和两次实地视网膜摄影。照片由两名眼科医生独立阅读。结果测量是照片的可分级性、药理学瞳孔扩张的必要性、是否存在糖尿病视网膜病变、新生血管和糖尿病视网膜病变的可疑评估，以及评分者之间的一致性。在研究的人群中，11.3%的患者需要瞳孔扩张，图像的平均传输时间为73秒，12.0%的患者照片无法分级，10.4%的照片可分级的患者被评估为“疑似糖尿病视网膜病变”，2.0%的患者被评估为需要紧急转诊。在所有可分级的患者中，红色病变占3.5%，明亮病变占1.6%。1例患者出现椎间盘新生血管。1型患者“疑似糖尿病视网膜病变”的比例（34.5%）明显高于2型患者（9.4%）。译员间协议kappa为0.93。基于网络的筛查，使用开源技术和未压缩的图像，在初级保健环境中是可行的，具有较高的评分一致性。按需扩张可能是视网膜摄影的一种明智的方法。1型糖尿病患者中“疑似糖尿病视网膜病变”的高发病率表明，针对这些患者的基于网络的糖尿病视网膜病变筛查程序可能会检测到原本未被发现的糖尿病视网膜病变。
The objective of this study was to evaluate the feasibility of ATA category 2 Web-based screening for diabetic retinopathy in a primary care population in the Netherlands. A total of 1,676 patients in a primary care setting, with diabetes, without known diabetic retinopathy, and without previous screening by an ophthalmologist, were included between January 1 and December 31, 2003. Patients underwent a brief questionnaire and two field retinal photography. Photographs were independently read by two ophthalmologists. Outcome measures were gradability of the photographs, need for pharmacologic pupil dilation, assessment as suspect for presence of diabetic retinopathy, of neovascularization and of diabetic retinopathy, and agreement between graders.Of the population studied, 11.3% of patients required pupil dilation, average transmission time of images was 73 sec, 12.0% of patients had ungradable photographs, 10.4% of the patients with gradable photographs were assessed as "suspect for diabetic retinopathy," and 2.0% were assessed to need urgent referral. Red lesions were present in 3.5% and bright lesions were present in 1.6% of all gradable patients. Neovascularization of the disk was found in one patient. Type 1 patients had much higher rates of "suspect for diabetic retinopathy" (34.5%) than type 2 patients (9.4%). Interrater agreement kappa was 0.93.Web-based screening, using open source technology and uncompressed images, is feasible in a primary care setting, with a high rate of inter-rater agreement. Dilate-as-needed may be a sensible approach for retinal photography. The high incidence of "suspect for diabetic retinopathy" in type 1 diabetes patients illustrates that web-based diabetic retinopathy screening programs for these patients may detect diabetic retinopathy that would otherwise have gone undetected.