Barcatali M-G, Denion E, Miocque S, Reznik Y, Joubert M, Morera J, Rod A, Mouriaux F
Service d'ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, 14003 Caen, France.
Service d'endocrinologie, CHU de Caen, avenue de la Côte-de-Nacre, 14003 Caen, France.
J Fr Ophtalmol. 2015 Apr;38(4):340-6. doi: 10.1016/j.jfo.2015.01.003.
Since 2010, the High Authority for health (HAS) recommends the use of non-mydriatic fundus camera for diabetic retinopathy screening. The purpose of this study is to evaluate the results of screening for diabetic retinopathy using the non-mydriatic retinal camera by a physician's assistant in the endocrinology service.
This is a retrospective study of all diabetic patients hospitalized in the endocrinology department between May 2013 and November 2013. For each endocrinology patient requiring screening, a previously trained physician's assistant performed fundus photos. The ophthalmologist then provided a written interpretation of the photos on a consultant's sheet.
Of the 120 patients screened, 40 (33.3%) patients had uninterpretable photos. Among the 80 interpretable photos, 64 (53.4%) patients had no diabetic retinopathy, and 16 (13.3%) had diabetic retinopathy. No patient had diabetic maculopathy.
Specific quality criteria were established by the HAS for screening for diabetic retinopathy using the non-mydriatic retinal camera in order to ensure sufficient sensitivity and specificity. In our study, the two quality criteria were not achieved: the rates of uninterpretable photos and the total number of photos analyzed in a given period.
In our center, we discontinued this method of diabetic retinopathy screening due to the high rate of uninterpretable photos. Due to the logistic impossibility of the ophthalmologists taking all the fundus photos, we proposed that the ophthalmic nurses take the photos. They are better trained in the use of the equipment, and can confer directly with an ophthalmologist in questionable cases and to obtain pupil dilation as necessary.
自2010年以来，法国卫生高级管理局（HAS）建议使用免散瞳眼底相机进行糖尿病视网膜病变筛查。本研究的目的是评估内分泌科医师助理使用免散瞳视网膜相机进行糖尿病视网膜病变筛查的结果。
这是一项对2013年5月至2013年11月期间在内分泌科住院的所有糖尿病患者的回顾性研究。对于每位需要筛查的内分泌科患者，由一名预先培训过的医师助理进行眼底拍照。然后眼科医生在会诊单上对照片进行书面解读。
在筛查的120例患者中，40例（33.3%）患者的照片无法解读。在80张可解读的照片中，64例（53.4%）患者没有糖尿病视网膜病变，16例（13.3%）有糖尿病视网膜病变。没有患者患有糖尿病黄斑病变。
HAS制定了使用免散瞳视网膜相机筛查糖尿病视网膜病变的特定质量标准，以确保足够的敏感性和特异性。在我们的研究中，这两个质量标准未达到：无法解读的照片率以及在给定时间段内分析的照片总数。
在我们中心，由于无法解读的照片率很高，我们停止了这种糖尿病视网膜病变筛查方法。由于眼科医生不可能拍摄所有眼底照片，我们建议由眼科护士拍照。他们在设备使用方面接受了更好的培训，并且在有疑问的情况下可以直接与眼科医生协商，并在必要时进行散瞳。
