Anderson S, Broadbent D M, Swain J Y S, Vora J P, Harding S P
St Paul's Eye Unit Royal Liverpool University Hospital Liverpool, UK.
Eye (Lond). 2003 Aug;17(6):711-6. doi: 10.1038/sj.eye.6700487.
To evaluate the feasibility and cost of screening for diabetic eye disease in homebound nursing home residents not attending a systematic screening programme.
Postal survey identification of residents with diabetes in all nursing homes in Liverpool. An ophthalmologist and nurse performed Bailey-Lovie logmar visual acuity (VA), portable slit-lamp examination, fundus photography, and subjective assessment of ability to cooperate with treatment in a sample of homes. Modified Wisconsin photographic grading was performed. Screen-positive patients were invited to a dedicated assessment clinic. Sight-threatening diabetic eye disease (STED) was defined as any of: moderate preproliferative retinopathy or worse, circinate maculopathy, or exudate within 1 disc diameter of fixation.
A total of 54 (78%) nursing homes responded reporting 199/2427 (8.2%) residents with diabetes. Of these, 64/80 (80%) residents in 17 homes were examined: VA possible in 50 (78%); slit-lamp examination in 56 (88%); gradable photographs in at least one eye in 34 (53%); STED in 12 (35%) patients. In all, 35 (70%) patients had Snellen-equivalent VA worse than 6/12 in the better eye, of whom 13 (26%) were worse than 6/60. Of 29 screen positive patients, 12 attended the assessment clinic: one was unable to cooperate outside the home; 11 continue under ophthalmic review, four for previously undetected STED of which one listed for laser photocoagulation. Total cost pound 16,980; cost per screen event pound 60.30.
Systematic eye screening in homebound patients with diabetes detects disease but follow-up and treatment is only feasible in a small proportion and at high cost. Alternative targeted assessment is recommended.
评估在未参加系统性筛查项目的居家养老院居民中筛查糖尿病眼病的可行性和成本。
通过邮政调查确定利物浦所有养老院中患有糖尿病的居民。一名眼科医生和一名护士在部分养老院对居民进行了贝利-洛维对数视力（VA）检查、便携式裂隙灯检查、眼底摄影以及对配合治疗能力的主观评估。采用改良的威斯康星摄影分级法。筛查呈阳性的患者被邀请到专门的评估诊所。威胁视力的糖尿病眼病（STED）定义为以下任何一种情况：中度增殖前期视网膜病变或更严重病变、环状黄斑病变或在注视点1个视盘直径范围内有渗出物。
共有54家（78%）养老院回复，报告有199/2427名（8.2%）居民患有糖尿病。其中，对17家养老院的64/80名（80%）居民进行了检查：50名（78%）居民可行视力检查；56名（88%）居民可行裂隙灯检查；34名（53%）居民至少一只眼睛的照片可用于分级；12名（35%）患者患有STED。总体而言，35名（70%）患者较好眼睛的Snellen等效视力差于6/12，其中13名（26%）差于6/60。在29名筛查呈阳性的患者中，12名患者前往评估诊所：1名患者在家外无法配合；11名患者继续接受眼科复查，4名患者因之前未发现STED而复查，其中1名患者已安排进行激光光凝治疗。总成本为16,980英镑；每次筛查事件的成本为60.30英镑。
对居家糖尿病患者进行系统性眼部筛查可发现疾病，但后续随访和治疗仅在小部分患者中可行且成本高昂。建议采用替代的针对性评估方法。
