The diagnostic accuracy of single- and five-field fundus photography in diabetic retinopathy screening by primary care physicians
The diagnostic accuracy of single- and five-field fundus photography in diabetic retinopathy screening by primary care physicians
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DOI：
10.4103/ijo.ijo_657_17
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发表时间：
2018-01-01
影响因子：
3.1
通讯作者：
Hlowchitsieng, Thanita
中科院分区：
文献类型：
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作者：
Srihatrai, Parinya;Hlowchitsieng, Thanita
目的：目的是评估数字眼底照相在一所大学医院糖尿病视网膜病变（DR）筛查中的诊断准确性。方法：这是一项以医院为基础的横断面研究。招募了198名糖尿病患者，由两名眼科医生进行全面的眼科检查。使用数字化非散瞳眼底照相机拍摄五视野眼底照片，然后由经过培训的初级保健医生通过单视野45度和五视野眼底照相对DR的严重程度进行分级。DR分级的敏感性和特异性以眼科医生的检查结果作为金标准。结果如下：当分析参与者363只眼睛的眼底照片是否存在DR时，两位初级保健医生之间存在实质性的一致性，单视野照片解释的kappa = 0.6226，五视野照片解释的kappa = 0.6939。单视野照片检测DR的灵敏度和特异性分别为70.7%（95%置信区间[CI]; 60.2%-79.7%）和99.3%（95% CI; 97.4%-99.9%）。五视野摄影的敏感性和特异性分别为84.5%（95% CI; 75.8%-91.1%）和98.6%（95% CI; 96.5%-99.6%）。单视野照片的受试者工作特性为0.85（0.80-0.90），五视野照片的受试者工作特性为0.92（0.88-0.95）。结论：初级保健医生眼底照片检测DR的敏感性和特异性是可以接受的。单视野和五视野数字眼底摄影各自代表了具有可接受的准确性的方便的筛查工具。
Purpose: The aim is to evaluate the diagnostic accuracy of digital fundus photography in diabetic retinopathy (DR) screening at a single university hospital. Methods: This was a cross-sectional hospital-based study. One hundred and ninety-eight diabetic patients were recruited for comprehensive eye examination by two ophthalmologists. Five-field fundus photographs were taken with a digital, nonmydriatic fundus camera, and trained primary care physicians then graded the severity of DR present by single-field 45 degrees and five-field fundus photography. Sensitivity and specificity of DR grading were reported using the findings from the ophthalmologists' examinations as a gold standard. Results: When fundus photographs of the participants' 363 eyes were analyzed for the presence of DR, there was substantial agreement between the two primary care physicians, kappa = 0.6226 for single-field and 0.6939 for five-field photograph interpretation. The sensitivity and specificity of DR detection with single-field photographs were 70.7% (95% Confidence interval [CI]; 60.2%-79.7%) and 99.3% (95% CI; 97.4%-99.9%), respectively. Sensitivity and specificity for five-field photographs were 84.5% (95% CI; 75.8%-91.1%) and 98.6% (95% CI; 96.5%-99.6%), respectively. The receiver operating characteristic was 0.85 (0.80-0.90) for single-field photographs and 0.92 (0.88-0.95) for five-field photographs. Conclusion: The sensitivity and specificity of fundus photographs for DR detection by primary care physicians were acceptable. Single-and five-field digital fundus photography each represent a convenient screening tool with acceptable accuracy.