数字成像、视网膜摄影和验光师检查在糖尿病视网膜病变筛查中的比较评估。

A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy.

作者信息

Olson J A, Strachan F M, Hipwell J H, Goatman K A, McHardy K C, Forrester J V, Sharp P F

机构信息

Department of Ophthalmology, The Eye Clinic, Aberdeen Royal Infirmary, Grampian University Hospitals NHS Trust, Aberdeen, UK.

出版信息

Diabet Med. 2003 Jul;20(7):528-34. doi: 10.1046/j.1464-5491.2003.00969.x.

DOI:10.1046/j.1464-5491.2003.00969.x

PMID:12823232

Abstract

AIMS

To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme.

METHODS

A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n=586; graded manually), colour slides (n=586; graded manually), and slit-lamp examination by specially trained optometrists (n=485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed.

RESULTS

Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52-88) and a specificity of 90% (87-93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82-98) and a specificity of 87% (84-90), and for colour slides, a sensitivity of 96% (87-100) and a specificity of 89% (86-91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77-89) and a specificity of 71% (66-75) and diabetic macular oedema with a sensitivity of 76% (53-92) and a specificity of 85% (82-88).

CONCLUSIONS

Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.

摘要

目的

比较由训练有素的验光师进行的数字视网膜成像、眼底照相和裂隙灯生物显微镜检查在糖尿病视网膜病变筛查中的各自表现。评估自动数字图像分析对筛查项目的潜在贡献。

方法

从糖尿病诊所招募的586名患者接受了三到四种散瞳视网膜检查方法。将数字成像（n = 586；人工分级）、彩色幻灯片（n = 586；人工分级）以及由经过专门训练的验光师进行的裂隙灯检查（n = 485）的各自表现，与对医学视网膜有特殊兴趣的眼科医生进行的裂隙灯生物显微镜检查的参考标准进行评估。还评估了计算机对数字图像的自动分级表现。

结果

验光师进行的裂隙灯检查对可转诊的糖尿病视网膜病变的敏感性为73%（52 - 88），特异性为90%（87 - 93）。使用双视野成像时，无赤数字图像的人工分级敏感性为93%（82 - 98），特异性为87%（84 - 90）；对于彩色幻灯片，敏感性为96%（87 - 100），特异性为89%（86 - 91）。单黄斑视野成像的两种方法取得了几乎相同的结果。数字成像的技术失败率（患者的4.4%）低于彩色幻灯片摄影（11.9%）。对数字图像应用自动分级方案可检测到任何视网膜病变，敏感性为83%（77 - 89），特异性为71%（66 - 75）；检测糖尿病黄斑水肿的敏感性为76%（53 - 92），特异性为85%（82 - 88）。