Friedman David S, Cassard Sandra D, Williams Sherill K, Baldonado Kira, O'Brien Rebecca W, Gower Emily W
Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD 21287, USA.
Ophthalmic Epidemiol. 2013 Aug;20(4):201-11. doi: 10.3109/09286586.2013.789533.
To evaluate which components of a vision screening process are most effective in identifying individuals who need eye care services.
Subjects visiting a free health clinic were screened using visual acuity and a questionnaire. Persons who failed screening were referred for a professional eye examination.
A total of 1380 of 3004 screened persons (46%) screened positive on question(s) or distance visual acuity; 81% of screened positives were referred for an eye exam, <50% of the positives attended the examination, and one-third had ≥1 problem requiring intervention or monitoring. The most common problem was distance refractive error that, once corrected, improved vision by two or more lines, followed by glaucoma or glaucoma suspect (8.9%), visually significant cataract (7.2%), and diabetic retinopathy (2.5%). Ninety-four subjects who screened negative ("normal") were examined; nearly half of these had 2+ lines of visual acuity improvement with refraction (from 20/40 or 20/32 to 20/20). Sensitivity for detecting specific eye conditions varied substantially, ranging from 0-83% for individual screening questions. Time since last exam and distance acuity <20/50 were the most sensitive questions for visually significant cataract; however, their specificity was low. No combination of questions and acuity testing had both high sensitivity and specificity.
Vision problems requiring intervention were common among this relatively young population, but no combination of screening questions and vision testing proved effective for screening. More than half of those who screened positive never showed for an examination, indicating that on-site eye exams might be more effective.
评估视力筛查过程中的哪些组成部分在识别需要眼科护理服务的个体方面最有效。
对前往免费健康诊所的受试者进行视力和问卷调查筛查。筛查未通过的人被转介进行专业眼科检查。
在3004名接受筛查的人中，共有1380人（46%）在问题或远视力方面筛查呈阳性；81%的筛查阳性者被转介进行眼科检查，<50%的阳性者参加了检查，三分之一的人有≥1个需要干预或监测的问题。最常见的问题是远屈光不正，一旦矫正，视力可提高两行或更多行，其次是青光眼或疑似青光眼（8.9%）、有视觉意义的白内障（7.2%）和糖尿病视网膜病变（2.5%）。对94名筛查为阴性（“正常”）的受试者进行了检查；其中近一半人通过验光视力提高了2行或更多行（从20/40或20/32提高到20/20）。检测特定眼部疾病的敏感性差异很大，单个筛查问题的敏感性范围为0-83%。上次检查后的时间和远视力<20/50是有视觉意义白内障最敏感的问题；然而，它们的特异性较低。没有任何问题和视力测试的组合同时具有高敏感性和特异性。
在这个相对年轻的人群中，需要干预的视力问题很常见，但没有任何筛查问题和视力测试的组合被证明对筛查有效。超过一半的筛查阳性者从未前来检查，这表明现场眼科检查可能更有效。
