Department of Ophthalmology, Hospital de Navarra, 31007 Pamplona, Spain.
J Telemed Telecare. 2010;16(8):429-32. doi: 10.1258/jtt.2010.091204. Epub 2010 Sep 2.
We evaluated tele-ophthalmology for diabetic retinopathy screening in a primary care setting. Four general practitioners (GPs) were taught to assess non-mydriatic retinography images of patients with diabetes. After training, a total of 1223 patients were screened using this method: 926 (76%) did not have diabetic retinopathy and 297 (24%) were referred for an ophthalmologic assessment. Of the 297 patients, 186 (15%) did not have diabetic retinopathy and were considered to be false positives, 85 (7%) had diabetic retinopathy and in 26 cases (2%) the retinography images were unreadable. The specificity of GPs for detecting diabetic retinopathy by non-mydriatic retinography was 83%. Ophthalmologists also assessed 120 patients who had been diagnosed as normal to detect false negatives. Ten patients (8.3%) had mild non-proliferative diabetic retinopathy with small isolated retinal hemorrhages. Only one patient (0.8%) had treatable diabetic retinopathy with hard exudates and microaneurysms. The sensitivity of GPs for detecting diabetic retinopathy was 90.9%; the sensitivity for detecting treatable lesions was 99.2%. We concluded that adequately trained GPs can screen for treatable lesions of diabetic retinopathy with a very high level of reliability using non-mydriatic retinography.
我们评估了初级保健环境中的远程眼科糖尿病视网膜病变筛查。四名全科医生（GP）接受了培训，以评估糖尿病患者的非散瞳视网膜摄影图像。经过培训，共有 1223 名患者接受了这种方法的筛查：926 名（76%）没有糖尿病视网膜病变，297 名（24%）被转诊进行眼科评估。在 297 名患者中，186 名（15%）没有糖尿病视网膜病变，被认为是假阳性，85 名（7%）患有糖尿病视网膜病变，在 26 例（2%）中，视网膜摄影图像无法读取。GP 通过非散瞳视网膜摄影检测糖尿病视网膜病变的特异性为 83%。眼科医生还评估了 120 名被诊断为正常的患者，以发现假阴性。10 名患者（8.3%）有轻度非增生性糖尿病视网膜病变，伴有孤立的视网膜小出血。只有 1 名患者（0.8%）有可治疗的糖尿病视网膜病变，伴有硬性渗出物和微动脉瘤。GP 检测糖尿病视网膜病变的敏感性为 90.9%；检测可治疗病变的敏感性为 99.2%。我们得出结论，经过适当培训的 GP 可以使用非散瞳视网膜摄影术非常可靠地筛查可治疗的糖尿病视网膜病变病变。
