Rhatigan M C, Leese G P, Ellis J, Ellingford A, Morris A D, Newton R W, Roxburgh S T
Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK.
Eye (Lond). 1999 Apr;13 ( Pt 2):166-9. doi: 10.1038/eye.1999.44.
Detection of diabetic retinopathy by screening is a major public health concern. Fundus photography has been shown to be a useful screening tool for the detection of diabetic retinopathy. In this paper the authors assess the incidence of blind and partially sighted registration due to diabetic eye disease in patients screened by a mobile fundus photography unit and identify the factors that contributed to loss of vision in the registered group.
A retrospective review of blind and partially sighted registrations between 1990 and 1995 was performed in a diabetic population screened by a mobile fundus photography unit in a region with a population of 390,000. The incidence of blind and partially sighted registration in the screened diabetic population was calculated. In the registered group, cause of visual loss, accuracy of photograph reporting, delay in laser treatment, adequacy of laser treatment and non-attendance rates at ophthalmic clinics were assessed.
Of the 5390 patients screened by the mobile unit over 6 years, 68 (210 per 10(5) patient-years) were registered blind or partially sighted, but in only 17 patients (53 per 10(5) patient-years) was this as a result of diabetes. The factors contributing to loss of vision were found to be failure of laser treatment, rapidly progressive disease and poor patient attendance.
As the majority of visual impairment in patients with diabetes is not due to diabetic retinopathy, this has important implications for screening programmes and may make the St Vincent Declaration targets difficult to achieve. The rate of new blind and partially sighted registration due to diabetes in the screened population was low at 53 per 10(5) patient-years (95% confidence interval, 29-76).
通过筛查来检测糖尿病视网膜病变是一个重大的公共卫生问题。眼底摄影已被证明是检测糖尿病视网膜病变的一种有用的筛查工具。在本文中，作者评估了由移动眼底摄影设备筛查的患者中因糖尿病眼病导致失明和视力部分丧失而进行登记的发生率，并确定了导致登记组视力丧失的因素。
对1990年至1995年间在一个有39万人口的地区由移动眼底摄影设备筛查的糖尿病患者群体中失明和视力部分丧失的登记情况进行回顾性研究。计算筛查的糖尿病患者群体中失明和视力部分丧失登记的发生率。在登记组中，评估视力丧失的原因、照片报告的准确性、激光治疗的延迟、激光治疗的充分性以及眼科诊所的未就诊率。
在6年时间里由移动设备筛查的5390例患者中，68例（每10⁵患者年210例）被登记为失明或视力部分丧失，但其中只有17例（每10⁵患者年53例）是由糖尿病导致的。导致视力丧失的因素包括激光治疗失败、疾病快速进展和患者就诊率低。
由于糖尿病患者的大多数视力损害并非由糖尿病视网膜病变所致，这对筛查项目具有重要意义，可能使《圣文森特宣言》的目标难以实现。在筛查人群中，因糖尿病导致的新失明和视力部分丧失登记率较低，为每10⁵患者年53例（95%置信区间，29 - 76）。
