Farley Tillman F, Mandava Naresh, Prall F Ryan, Carsky Cece
Salud Family Health Centers, Fort Lupton, Colorado 80621, USA.
Ann Fam Med. 2008 Sep-Oct;6(5):428-34. doi: 10.1370/afm.857.
Diabetic patients with limited access to ophthalmologists have low screening rates for diabetic retinopathy. We evaluated a diabetic retinopathy screening program in a community health center using single images taken with a nonmydriatic retinal camera and primary care clinicians trained to read retinal images.
This study was conducted from 2001 to 2004 in a multisite community health center staffed by family physicians, advanced practice nurses, and physician's assistants. The clinic serves a primarily low-income, Hispanic population. Clinic clinicians were trained to read the retinal photographs. All images were overread by an ophthalmologist. Patients were referred to eye care specialists for severe diabetic retinopathy, unknown or other abnormality, or inadequate photographs. We analyzed agreement between the clinicians and the ophthalmologist in recognizing diabetic retinopathy and in determining which patients needed referral. We also analyzed overall screening rates based on clinic access to the camera.
One thousand forty diabetic patients were screened for diabetic retinopathy at the health center. One hundred thirteen (10.9%) were found to have diabetic retinopathy, 46 severe enough to warrant referral to an ophthalmologist. The clinicians failed to refer 35 (10.2%) of the 344 patients the ophthalmologist believed needed referral. Most cases of missed referral were due to failure to recognize an inadequate photograph or for abnormalities other than diabetic retinopathy. Screening rates were better in the clinic with a permanent camera.
Primary care clinicians trained to read single images from a retinal camera have acceptable accuracy in screening for diabetic retinopathy. Further training may be necessary to recognize other common abnormalities.
难以获得眼科医生服务的糖尿病患者对糖尿病视网膜病变的筛查率较低。我们在一个社区健康中心评估了一项糖尿病视网膜病变筛查项目，该项目使用非散瞳视网膜相机拍摄的单张图像，并由经过培训以解读视网膜图像的初级保健临床医生进行操作。
本研究于2001年至2004年在一个多站点社区健康中心开展，该中心配备家庭医生、高级执业护士和医师助理。该诊所主要服务低收入的西班牙裔人群。诊所临床医生接受了解读视网膜照片的培训。所有图像均由一名眼科医生进行复核。患有严重糖尿病视网膜病变、存在未知或其他异常情况或照片质量不佳的患者被转诊至眼科护理专家处。我们分析了临床医生与眼科医生在识别糖尿病视网膜病变以及确定哪些患者需要转诊方面的一致性。我们还根据诊所使用相机的情况分析了总体筛查率。
在健康中心对1040名糖尿病患者进行了糖尿病视网膜病变筛查。其中113名（10.9%）被发现患有糖尿病视网膜病变，46名病情严重到足以转诊至眼科医生处。在眼科医生认为需要转诊的344名患者中，临床医生未能转诊35名（10.2%）。大多数漏诊病例是由于未能识别照片质量不佳或存在糖尿病视网膜病变以外的异常情况。配备永久相机的诊所筛查率更高。
经过培训以解读视网膜相机单张图像的初级保健临床医生在筛查糖尿病视网膜病变方面具有可接受的准确性。可能需要进一步培训以识别其他常见异常情况。
