Buxton M J, Sculpher M J, Ferguson B A, Humphreys J E, Altman J F, Spiegelhalter D J, Kirby A J, Jacob J S, Bacon H, Dudbridge S B
Health Economics Research Group, Brunel University, Uxbridge, UK.
Diabet Med. 1991 May;8(4):371-7. doi: 10.1111/j.1464-5491.1991.tb01612.x.
The results of the screening of 3318 diabetic patients for sight-threatening diabetic retinopathy in three UK centres are reported. The aims of the study were to determine the extent of diabetic retinopathy in the screened population and to assess the relative effectiveness of different screening methods in appropriately referring cases from a diabetic population, in a context very close to a routine clinical service. Patients were assessed by ophthalmoscopic examination by an ophthalmological clinical assistant. The clinical assistants' referral grades formed the reference standard against which to assess the effectiveness of other screening methods including ophthalmoscopy by primary screeners who were general practitioners (GPs), ophthalmic opticians and hospital physicians, and the assessment by consultant ophthalmologists of non-mydriatic Polaroid fundus photography. The performance of primary screeners based on ophthalmoscopy ranged from a sensitivity of 0.41, with a specificity of 0.89, for one of the GP groups, to a sensitivity of 0.67, with a specificity of 0.96, for the hospital physician group. The performance of the non-mydriatic camera ranged from a sensitivity of 0.35, with a specificity of 0.95, to a sensitivity of 0.67, with a specificity of 0.98.
本文报告了在英国三个中心对3318名糖尿病患者进行威胁视力的糖尿病视网膜病变筛查的结果。本研究的目的是确定筛查人群中糖尿病视网膜病变的程度，并在非常接近常规临床服务的背景下，评估不同筛查方法在从糖尿病患者群体中恰当转诊病例方面的相对有效性。患者由眼科临床助理通过检眼镜检查进行评估。临床助理的转诊分级构成了参考标准，据此评估其他筛查方法的有效性，这些方法包括由全科医生（GP）、眼科验光师和医院医生等初级筛查人员进行的检眼镜检查，以及由眼科顾问医生对非散瞳宝丽来眼底摄影的评估。基于检眼镜检查的初级筛查人员的表现，其中一个GP组的灵敏度为0.41，特异度为0.89，而医院医生组的灵敏度为0.67，特异度为0.96。非散瞳相机的表现，灵敏度从0.35（特异度为0.95）到0.67（特异度为0.98）不等。
