Choremis Johanna, Chow David R
Department of Ophthalmology, McGill University, Montreal, Que.
Can J Ophthalmol. 2003 Dec;38(7):575-9. doi: 10.1016/s0008-4182(03)80111-4.
A diabetic retinopathy screening program was introduced in September 2000 at a university-affiliated hospital in Montreal to meet the demands of an overburdened health care system. In this article we describe our initial experience with this program.
A Canon CR6-45NM nonmydriatic 45 degrees camera was installed in the outpatient endocrinology clinic of the hospital. All patients who visited the clinic between September 2000 and January 2001 agreed to participate in the program. For each patient, a short questionnaire (age, sex, type of diabetes mellitus, time since diagnosis, prior retinal laser therapy and presence of end-organ involvement) was filled in. Subsequently at least two photographs were obtained of each eye. The photographs were sent via the hospital intranet to a retinal specialist within the hospital. The specialist reviewed the images unchanged and sent a report (grading of the level of diabetic retinopathy, presence or absence of macular hard exudates, quality of the images obtained and follow-up recommendations) via the hospital intranet to the endocrinology service. If the images were judged to be of poor quality and could not be read by the retina specialist, the patient was asked to see his or her regular ophthalmologist.
Images of 830 eyes of 415 patients (211 men and 204 women with a mean age of 57.5 years) were obtained. Most (83.6%) had type 2 diabetes. The average duration of disease was 13.3 years. Macular hard exudates were observed in 50 eyes (6.0%). Nonproliferative diabetic retinopathy was noted in 117 eyes (14.1%) and proliferative diabetic retinopathy in 15 eyes (1.8%). Unexpected findings included epiretinal membranes (in three eyes), macular holes (in two), bilateral cotton-wool spots (in one patient) and central retinal vein occlusion (in one eye). Overall, 10% of the patients were referred to a retina specialist based on the screening photographs. The main difficulty encountered with the screening program was image inconsistency. Overall, 35% of the images graded were felt to be of poor quality, the most common reason being poor exposure (84.4%). The quality of the images improved significantly over the study period (p < 0.01). Images obtained from patients aged 65 years or more were consistently poorer than those obtained from patients less than 65 years of age (p < 0.001).
Despite the imperfections of such a system, our experience was favourable, allowing us to screen large numbers of patients in a cost-effective, reliable manner.
2000年9月，蒙特利尔一家大学附属医院推出了糖尿病视网膜病变筛查项目，以满足不堪重负的医疗保健系统的需求。在本文中，我们描述了该项目的初步经验。
在医院门诊内分泌诊所安装了一台佳能CR6 - 45NM免散瞳45度相机。2000年9月至2001年1月期间到该诊所就诊的所有患者均同意参与该项目。为每位患者填写一份简短问卷（年龄、性别、糖尿病类型、确诊时间、既往视网膜激光治疗情况以及是否存在终末器官受累情况）。随后，为每只眼睛至少拍摄两张照片。照片通过医院内部网络发送给医院的一位视网膜专家。该专家直接查看图像，并通过医院内部网络向内分泌科发送一份报告（糖尿病视网膜病变分级、是否存在黄斑硬性渗出、所获图像质量以及随访建议）。如果图像被判定质量不佳且视网膜专家无法解读，则要求患者去看其常规眼科医生。
共获取了415例患者（211名男性和204名女性，平均年龄57.5岁）830只眼睛的图像。大多数患者（83.6%）患有2型糖尿病。疾病平均病程为13.3年。50只眼睛（6.0%）观察到黄斑硬性渗出。117只眼睛（14.1%）发现非增殖性糖尿病视网膜病变，15只眼睛（1.8%）发现增殖性糖尿病视网膜病变。意外发现包括视网膜前膜（3只眼睛）、黄斑裂孔（2只眼睛）、双侧棉絮斑（1例患者）以及视网膜中央静脉阻塞（1只眼睛）。总体而言，10%的患者基于筛查照片被转诊至视网膜专家处。筛查项目遇到的主要困难是图像不一致。总体而言，35%被分级的图像被认为质量不佳，最常见原因是曝光不足（84.4%）。在研究期间，图像质量显著改善（p < 0.01）。65岁及以上患者所获图像始终比65岁以下患者所获图像质量差（p < 0.001）。
尽管这样一个系统存在缺陷，但我们的经验是良好的，使我们能够以具有成本效益且可靠的方式筛查大量患者。
