Kopplin Laura J, Mansberger Steven L
Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Public Health & Preventative Medicine, Oregon Health & Science University, Portland, Oregon; Devers Eye Institute, Legacy Health, Portland, Oregon.
Am J Ophthalmol. 2015 Sep;160(3):538-546.e3. doi: 10.1016/j.ajo.2015.05.033. Epub 2015 Jun 4.
To determine the predictive value of ophthalmic screening tests with visually significant eye disease in a cohort of American Indian/Alaskan Natives from the Pacific Northwest.
Validity assessment of a possible screening protocol.
Ophthalmic technicians performed a screening examination including medical and ocular history, best-corrected visual acuity, limbal anterior chamber depth assessment, frequency-doubling technology perimetry (FDT, C-20-5), confocal scanning laser ophthalmoscopy, nonmydriatic digital photography, and tonometry on 429 participants. An ophthalmologist performed a comprehensive eye examination on subjects with 1 or more abnormal screening tests and a random selection of those with normal screening tests. We used univariate and multivariate logistic regression to determine the association between abnormal screening test results and visually significant eye disease. We also determined the predictive value of screening tests with ocular disease.
Univariate analysis identified history of eye disease or diabetes mellitus (P < .001), visual acuity <20/40 (P < .001), abnormal/poor-quality confocal scanning laser ophthalmoscopy (P < .001), abnormal FDT (P < .001), and abnormal/poor-quality nonmydriatic imaging (P < .001) as associated with visually significant eye disease. A multivariate analysis found visually significant eye disease to be associated (P < .001; receiver operating characteristic curve area = 0.827, negative predictive value = 84%) with 4 screening tests: visual acuity <20/40, abnormal/poor-quality nonmydriatic imaging, abnormal FDT, and abnormal/poor-quality confocal scanning laser ophthalmoscopy.
Ophthalmic technicians performing a subset of screening tests may provide an accurate and efficient means of screening for eye disease in an American Indian/Alaskan Native population. Confirmation of these results in other populations, particularly those with a different profile of disease prevalence, is needed.
确定眼部筛查测试对来自太平洋西北地区的美国印第安人/阿拉斯加原住民队列中具有视觉显著意义的眼病的预测价值。
对一种可能的筛查方案进行有效性评估。
眼科技术人员对429名参与者进行了筛查检查，包括病史和眼部病史、最佳矫正视力、角膜缘前房深度评估、倍频技术视野检查（FDT，C - 20 - 5）、共焦扫描激光眼底镜检查、免散瞳数码摄影和眼压测量。眼科医生对1项或多项筛查测试异常的受试者以及随机选择的筛查测试正常的受试者进行了全面的眼部检查。我们使用单变量和多变量逻辑回归来确定筛查测试结果异常与具有视觉显著意义的眼病之间的关联。我们还确定了眼部疾病筛查测试的预测价值。
单变量分析确定眼病或糖尿病病史（P <.001）、视力<20/40（P <.001）、共焦扫描激光眼底镜检查异常/质量差（P <.001）、FDT异常（P <.001）以及免散瞳成像异常/质量差（P <.001）与具有视觉显著意义的眼病相关。多变量分析发现，具有视觉显著意义的眼病与4项筛查测试相关（P <.001；受试者操作特征曲线面积 = 0.827，阴性预测值 = 84%）：视力<20/40、免散瞳成像异常/质量差、FDT异常以及共焦扫描激光眼底镜检查异常/质量差。
进行部分筛查测试的眼科技术人员可能为美国印第安人/阿拉斯加原住民人群的眼病筛查提供一种准确且有效的方法。需要在其他人群中，特别是那些疾病患病率情况不同的人群中对这些结果进行验证。
