Pasquale Louis R, Asefzadeh Baharak, Dunphy Robert W, Fisch Barry M, Conlin Paul R
Ocular Telehealth Center, VA Boston Healthcare System-Jamaica Plain Campus, Jamaica Plain, Massachusetts 02130, USA.
Optometry. 2007 Dec;78(12):657-63. doi: 10.1016/j.optm.2007.04.101.
Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM) in several studies. We assessed the sensitivity and specificity of a diabetes teleretinal program to identify the glaucoma-suspicious optic disc.
Outpatients with DM (N = 1,644) presenting to Veterans Affairs ambulatory clinics participated in a nonmydriatic digital retinal imaging (NMDRI) program. Technicians transmitted digital retinal images electronically to readers for grading and eye care recommendations. Patients were referred for ophthalmic care based on the level of diabetic retinopathy and other ocular findings, including optic nerve changes suspicious for glaucoma. We retrospectively reviewed the electronic medical records of patients labeled as glaucoma suspects (N = 175) and compared them with those of patients from the same imaging pool who were not regarded as glaucoma suspects (N = 175). Ophthalmic data obtained from a comprehensive eye examination after digital retinal imaging was used to determine which patients met predefined criteria for the optic disc suggestive of glaucoma.
Assessment of clinical data obtained after NMDRI found that 103 of 175 (59%) glaucoma suspects had glaucoma-suspicious optic discs. In the comparison group, only 7 of 175 (4%) had glaucoma-suspicious optic discs.
Although specificity was high (96%), modifications in diabetes teleretinal imaging programs are needed to improve the sensitivity of detecting the optic disc that is suspicious for glaucoma.
青光眼通常是一种起病隐匿的疾病，会导致严重的视觉后果，多项研究已明确其与糖尿病（DM）存在正相关。我们评估了糖尿病远程视网膜病变项目识别可疑青光眼视盘的敏感性和特异性。
到退伍军人事务门诊就诊的糖尿病门诊患者（N = 1644）参与了一项非散瞳数字视网膜成像（NMDRI）项目。技术人员将数字视网膜图像通过电子方式传输给阅片者进行分级并给出眼部护理建议。根据糖尿病视网膜病变的程度以及包括视神经改变等其他眼部检查结果，将患者转诊至眼科进行治疗，其中视神经改变可疑为青光眼。我们回顾性分析了被标记为青光眼疑似患者（N = 175）的电子病历，并将其与来自同一成像组但未被视为青光眼疑似患者（N = 175）的病历进行比较。通过数字视网膜成像后进行的全面眼部检查所获得的眼科数据，用于确定哪些患者符合青光眼可疑视盘的预定义标准。
对NMDRI后获得的临床数据进行评估发现，175例（59%）青光眼疑似患者中有103例存在青光眼可疑视盘。在对照组中，175例患者中只有7例（4%）存在青光眼可疑视盘。
尽管特异性较高（96%），但仍需要对糖尿病远程视网膜成像项目进行改进，以提高检测可疑青光眼视盘的敏感性。
