Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK.
Eye (Lond). 2010 Sep;24(9):1515-9. doi: 10.1038/eye.2010.77. Epub 2010 Jun 18.
The aim of this study is to determine the outcomes following referral for glaucoma from routine optometric practice and the positive predictive value (PPV).
A prospective study of 441 referrals for glaucoma in the Portsmouth area was performed over 6 months. A positive outcome was defined when the patient had the diagnosis of glaucoma made or if there was a high index of suspicion of glaucoma requiring follow-up. The PPV was determined from positive outcome number/referral number.
The overall PPV was 0.37 (95% confidence interval 0.33-0.42). Open-angle glaucoma (OAG) was confirmed in 33 (7%) patients. A diagnosis of ocular hypertension was made in 49 (11%) patients and glaucoma suspect in 92 (21%) referrals. Two-thirds of optometrists recorded all 3 assessments: fields, intraocular pressure (IOP) and disc appearance, a figure representing 293 referrals (PPV 0.37). However the greatest referral accuracy was seen when only discs and IOPs were recorded (PPV 0.47). When all three tests were given as reasons for suspicion for glaucoma, the PPV was 0.71. The number of patients diagnosed with OAG from Portsea Island during the study period was 7, whereas the expected number of diagnosed patients was 29.
Wider use of perimetry by optometrists and increased reporting of all three tests has not led to an increase in PPV. There remain a considerable number of undiagnosed patients with glaucoma in the population.
本研究旨在确定从常规验光实践转诊至青光眼的结果和阳性预测值（PPV）。
对朴茨茅斯地区的 441 例青光眼转诊患者进行了为期 6 个月的前瞻性研究。阳性结果定义为患者被确诊为青光眼，或高度怀疑为青光眼需要随访。PPV 通过阳性结果数/转诊数确定。
总体 PPV 为 0.37（95%置信区间 0.33-0.42）。33 例（7%）患者被确诊为开角型青光眼（OAG）。49 例（11%）患者被诊断为高眼压症，92 例（21%）转诊患者被怀疑为青光眼。三分之二的验光师记录了所有 3 项评估：视野、眼内压（IOP）和眼底外观，这代表了 293 例转诊（PPV 为 0.37）。然而，当仅记录眼底和眼压时，转诊的准确率最高（PPV 为 0.47）。当所有三项检查均作为怀疑青光眼的原因时，PPV 为 0.71。在研究期间，朴茨茅斯岛上被诊断为 OAG 的患者人数为 7 人，而预期诊断患者人数为 29 人。
尽管验光师更广泛地使用了视野计，并且增加了对所有三项检查的报告，但 PPV 并没有提高。人群中仍有相当数量的未确诊青光眼患者。
