Norfolk and Norwich University Hospital, Norwich, UK.
Diabet Med. 2009 Oct;26(10):1040-7. doi: 10.1111/j.1464-5491.2009.02820.x.
To describe changes in risk profiles and yield in a screening programme and to investigate relationships between retinopathy prevalence, screening interval and risk factors.
We analysed a population of predominantly Type 2 diabetic patients, managed in general practice, and screened between 1990 and 2006, with up to 17 years' follow-up and up to 14 screening episodes each. We investigated associations between referable or sight-threatening diabetic retinopathy (STDR), screening interval and frequency of repeated screening, whilst adjusting for age, duration and treatment of diabetes, hypertension treatment and period.
Of 63 622 screening episodes among 20 788 people, 16 094 (25%) identified any retinopathy, 3136 (4.9%) identified referable retinopathy and 384 (0.60%) identified STDR. The prevalence of screening-detected STDR decreased by 91%, from 1.7% in 1991-1993 to 0.16% in 2006. The prevalence of referable retinopathy increased from 2.0% in 1991-1993 to 6.7% in 1998-2001, then decreased to 4.7% in 2006. Compared with screening intervals of 12-18 months, screening intervals of 19-24 months were not associated with increased risk of referable retinopathy [adjusted odds ratio 0.93, 94% confidence interval (CI) 0.82-1.05], but screening intervals of more than 24 months were associated with increased risk (odds ratio 1.56, 95% CI 1.41-1.75). Screening intervals of < 12 months were associated with high risks of referable retinopathy and STDR.
Over time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients.
描述筛查计划中风险概况和检出率的变化，并研究视网膜病变患病率、筛查间隔与危险因素之间的关系。
我们分析了一个主要为 2 型糖尿病患者的人群，这些患者在全科医生处接受管理，筛查时间从 1990 年至 2006 年，随访时间长达 17 年，每个患者最多接受 14 次筛查。我们在调整年龄、糖尿病病程和治疗、高血压治疗和时期的情况下，调查了可致盲或威胁视力的糖尿病视网膜病变（STDR）、筛查间隔和重复筛查频率之间的关系。
在 20788 名患者的 63622 次筛查中，有 16094 次（25%）发现任何视网膜病变，3136 次（4.9%）发现可致盲性视网膜病变，384 次（0.60%）发现 STDR。筛查发现的 STDR 患病率下降了 91%，从 1991-1993 年的 1.7%降至 2006 年的 0.16%。可致盲性视网膜病变的患病率从 1991-1993 年的 2.0%增加到 1998-2001 年的 6.7%，然后降至 2006 年的 4.7%。与 12-18 个月的筛查间隔相比，19-24 个月的筛查间隔并未增加可致盲性视网膜病变的风险（调整后的比值比为 0.93，94%置信区间为 0.82-1.05），但超过 24 个月的筛查间隔与增加的风险相关（比值比为 1.56，95%置信区间为 1.41-1.75）。筛查间隔<12 个月与可致盲性视网膜病变和 STDR 的高风险相关。
随着时间的推移，STDR 晚期诊断的风险降低，这可能归因于更早地诊断出较不严重的视网膜病变、降低了危险因素以及系统筛查。对于低风险患者，应考虑长达 24 个月的筛查间隔。
