Conlin Paul R, Asefzadeh Baharak, Pasquale Louis R, Selvin Gerald, Lamkin Rebecca, Cavallerano Anthony A
Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
Department of Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts, USA New England College of Optometry, Boston, Massachusetts, USA.
Br J Ophthalmol. 2015 Dec;99(12):1622-7. doi: 10.1136/bjophthalmol-2014-306536. Epub 2015 May 20.
BACKGROUND/AIMS: Digital retinal imaging using store-and-forward technology is used to screen for diabetic retinopathy (DR). Its usefulness in detecting non-diabetic eye diseases is uncertain. We determined the level of agreement between teleretinal imaging supplemented with visual acuity and intraocular pressure (IOP) measurements (ie, technology-assisted eye (TAE) exam) and a comprehensive eye exam in evaluation for DR and non-diabetic ocular conditions.
We conducted a prospective, observational study with two parallel evaluations. Patients with diabetes (n=317) had a TAE exam and a comprehensive eye exam on the same day. A subset of participants with normal baseline exams (n=72) had follow-up exams 1 year later. We measured the level of agreement for referable ocular findings.
Agreement for referable ocular findings was moderate (n=389, agreement: 77%; κ: 0.55), due in part to ungradable exams (22%). However, about half of the ungradable exams had findings that warranted referral. There was substantial agreement for follow-up exams (n=72, agreement: 93%; κ: 0.63). Among all gradable exams (n=303), the TAE exam had 86% sensitivity and 84% specificity for referable ocular findings, with high agreement (≥94%) for DR and other major ocular diagnoses.
There was moderate-to-substantial agreement between a TAE exam and a comprehensive eye exam for referable ocular findings in patients with diabetes. Ungradable exams were a frequent marker of ocular pathology. Teleretinal imaging may be a useful evaluation for both diabetic and non-diabetic ocular conditions.
背景/目的：使用存储转发技术的数字视网膜成像用于筛查糖尿病视网膜病变（DR）。其在检测非糖尿病性眼病方面的效用尚不确定。我们确定了补充视力和眼压（IOP）测量的远程视网膜成像（即技术辅助眼部（TAE）检查）与全面眼科检查在评估DR和非糖尿病性眼部疾病方面的一致性水平。
我们进行了一项前瞻性观察研究，有两个平行评估。糖尿病患者（n = 317）在同一天进行TAE检查和全面眼科检查。一部分基线检查正常的参与者（n = 72）在1年后进行了随访检查。我们测量了可转诊眼部检查结果的一致性水平。
可转诊眼部检查结果的一致性为中等（n = 389，一致性：77%；κ：0.55），部分原因是检查结果不可分级（22%）。然而，约一半不可分级的检查结果有需要转诊的情况。随访检查有高度一致性（n = 七十二，一致性：93%；κ：0.63）。在所有可分级检查（n = 303）中，TAE检查对可转诊眼部检查结果的敏感性为86%，特异性为84%，对DR和其他主要眼部诊断的一致性较高（≥94%）。
对于糖尿病患者的可转诊眼部检查结果，TAE检查与全面眼科检查之间存在中等至高度一致性。不可分级的检查是眼部病变的常见标志。远程视网膜成像可能对糖尿病和非糖尿病性眼部疾病都是一种有用的评估方法。
