Younis Naveed, Broadbent Deborah M, Vora Jiten P, Harding Simon P
Department of Diabetes and Endocrinology, Royal Liverpool University Hospital, UK.
Lancet. 2003 Jan 18;361(9353):195-200. doi: 10.1016/s0140-6736(03)12267-2.
Incidence data on which to base targets and protocols for screening for sight-threatening diabetic retinopathy are few. We aimed to investigate yearly and cumulative incidence of any retinopathy, maculopathy, and sight-threatening diabetic retinopathy in patients with type 2 diabetes in an established systematic programme and to calculate optimum screening intervals according to retinopathy grade at baseline.
We investigated all patients with type 2 diabetes registered with enrolled general practices (except those who were attending an ophthalmologist) who had retinopathy data available at baseline and at least one further screening event. To screen patients, we used non-stereoscopic three-field mydriatic photography and modified Wisconsin grading. Sight-threatening diabetic retinopathy was defined as moderate preproliferative retinopathy or worse, or clinically significant maculopathy in either or both eyes.
Results were obtained from 20 570 screening events. Yearly incidence of sight-threatening diabetic retinopathy in patients without retinopathy at baseline was 0.3% (95% CI 0.1-0.5) in the first year, rising to 1.8% (1.2-2.5) in the fifth year; cumulative incidence at 5 years was 3.9% (2.8-5.0). Rates of progression to sight-threatening diabetic retinopathy in year 1 by baseline status were: background 5.0% (3.5-6.5), and mild preproliferative 15% (10.2-19.8). For a 95% probability of remaining free of sight-threatening diabetic retinopathy, mean screening intervals by baseline status were: no retinopathy 5.4 years (95% CI 4.7-6.3), background 1.0 years (0.7-1.3), and mild preproliferative 0.3 years (0.2-0.5).
A 3-year screening interval could be safely adopted for patients with no retinopathy, but yearly or more frequent screening is needed for patients with higher grades of retinopathy.
用于制定威胁视力的糖尿病视网膜病变筛查目标和方案的发病率数据很少。我们旨在调查在一个既定的系统项目中2型糖尿病患者中任何视网膜病变、黄斑病变和威胁视力的糖尿病视网膜病变的年发病率和累积发病率,并根据基线时的视网膜病变分级计算最佳筛查间隔。
我们调查了所有在注册全科诊所登记的2型糖尿病患者(正在看眼科医生的患者除外),这些患者在基线时有视网膜病变数据且至少有一次进一步的筛查事件。为了筛查患者,我们使用了非立体三视野散瞳摄影和改良的威斯康星分级法。威胁视力的糖尿病视网膜病变定义为中度增殖前期视网膜病变或更严重病变,或单眼或双眼的临床显著性黄斑病变。
从20570次筛查事件中获得了结果。基线时无视网膜病变的患者中,威胁视力的糖尿病视网膜病变的年发病率在第一年为0.3%(95%CI 0.1 - 0.5),在第五年升至1.8%(1.2 - 2.5);5年时的累积发病率为3.9%(2.8 - 5.0)。根据基线状态,第1年进展为威胁视力的糖尿病视网膜病变的发生率为:背景性病变5.0%(3.5 - 6.5),轻度增殖前期病变15%(10.2 - 19.8)。对于95%的概率保持无威胁视力的糖尿病视网膜病变,根据基线状态的平均筛查间隔为:无视网膜病变5.4年(95%CI 4.7 - 6.3),背景性病变1.0年(0.7 - 1.3),轻度增殖前期病变0.3年(0.2 - 0.5)。
无视网膜病变的患者可以安全地采用3年的筛查间隔,但视网膜病变分级较高的患者需要每年或更频繁地进行筛查。