Rodríguez Villa S, Alonso Álvarez C, de Dios Del Valle R, Salazar Méndez R, Cuesta García M, Ruiz García M J, Cubillas Martín M, Rodríguez Vazquez M
Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
Hospital Comarcal Jarrio, Coaña, Asturias, España.
Arch Soc Esp Oftalmol. 2016 Sep;91(9):426-30. doi: 10.1016/j.oftal.2016.01.023. Epub 2016 Feb 18.
To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyse diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings.
An observational randomised study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure >22mmHg. Statistical analysis was performed using the SPSS program (Student t and χ(2) tests).
DR prevalence was 12.1%. Patients with glycosylated haemoglobin values >7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR (P<.05). 43.3% of patients correctly referred to ophthalmologists showed moderate to severe DR. Unnecessary referrals to specialists were improved from 91.7% in 2010 to 98.6% in 2014. It is estimated that the program has made a total saving of €152,550.45.
Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs.
确定远程眼科项目所涵盖的农村居民中糖尿病视网膜病变（DR）的患病率及危险因素。分析基层医疗医生的诊断准确性、与眼科医生的一致性以及节省的费用。
对394名纳入远程眼科项目的患者（2010年1月至2015年1月）进行了一项观察性随机研究。对临床特征、视网膜造影图像中的DR表现以及眼科医生要求二次解读的情况与之前既定标准（中度至重度DR的存在、视力丧失、图像质量差和/或眼压>22mmHg）之间的对应关系进行了分析。使用SPSS程序进行统计分析（Student t检验和χ²检验）。
DR患病率为12.1%。糖化血红蛋白值>7.68%的患者或接受胰岛素和口服降糖药联合治疗的患者患DR的风险更高（P<0.05）。正确转诊至眼科医生的患者中有43.3%表现为中度至重度DR。不必要的专科转诊从2010年的91.7%降至2014年的98.6%。据估计，该项目总共节省了152,550.45欧元。
远程眼科项目是DR筛查的有用工具。基层医疗医生能够区分需要专科护理的患者，避免不必要地转诊至眼科医生，并节省费用。
