Athikarisamy Sam E, Patole Sanjay, Lam Geoffrey C, Dunstan Catherine, Rao Shripada
Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
Br J Ophthalmol. 2015 Mar;99(3):281-8. doi: 10.1136/bjophthalmol-2014-304984. Epub 2014 Jul 7.
Retinopathy of prematurity (ROP) is one of the leading and preventable causes of blindness. The investigation of choice for diagnosing ROP is binocular indirect ophthalmoscope (BIO) done by ophthalmologists. Since the number of ophthalmologists available to do BIO examination is limited, especially in developing countries, there is a need for an alternate, cheap, reliable and feasible test. Telemedicine imaging with Digital Retinal Photography (DRP) is one such alternate diagnostic test which can be performed easily by non-ophthalmologists, with adequate training. Our objective was to conduct a systematic review to evaluate the accuracy of DRP performed by trained personnel (non-ophthalmologists) in diagnosing clinically significant ROP. Medline, EMBASE, CINAHL and Cochrane databases were searched independently by two authors. Eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. Six were included in the review (three prospective; N=120, three retrospective; N=579). Studies had methodological limitations on QUADAS-2. Because of the heterogeneity of studies, data could not be pooled to derive single-effect size estimates for sensitivity and specificity. The included studies reported sensitivity of 45.5-100% with the majority being more than 90%; specificity 61.7-99.8% with the majority being more than 90%, positive predictive value 61.5-96.6% and negative predictive value of 76.9-100% for diagnosing clinically significant ROP. We conclude that diagnostic accuracy of DRP must be established in prospective studies with adequate sample size where DRP is compared against the simultaneously performed BIO examination.
早产儿视网膜病变（ROP）是导致失明的主要可预防病因之一。诊断ROP的首选检查是由眼科医生进行的双目间接检眼镜（BIO）检查。由于能够进行BIO检查的眼科医生数量有限，尤其是在发展中国家，因此需要一种替代的、廉价、可靠且可行的检测方法。数字视网膜摄影（DRP）远程医疗成像就是这样一种替代诊断测试，经过适当培训的非眼科医生即可轻松进行。我们的目的是进行一项系统评价，以评估经过培训的人员（非眼科医生）使用DRP诊断具有临床意义的ROP的准确性。两名作者独立检索了Medline、EMBASE、CINAHL和Cochrane数据库。使用诊断准确性研究质量评估（QUADAS）-2对符合条件的研究进行评估，QUADAS-2是一种基于证据的工具，用于评估诊断准确性研究系统评价中的质量。该评价纳入了6项研究（3项前瞻性研究；N=120，3项回顾性研究；N=579）。这些研究在QUADAS-2上存在方法学局限性。由于研究的异质性，无法汇总数据以得出敏感性和特异性的单一效应量估计值。纳入的研究报告，诊断具有临床意义的ROP时，敏感性为45.5%-100%，大多数超过90%；特异性为61.7%-99.8%，大多数超过90%，阳性预测值为61.5%-96.6%，阴性预测值为76.9%-100%。我们得出结论，必须在样本量充足的前瞻性研究中确定DRP的诊断准确性，在这些研究中，将DRP与同时进行的BIO检查进行比较。
