Hughes Daniel, Nair Sunil, Harvey John N
1 Diabetes Research Group, School of Medical Sciences, Bangor University, Bangor, UK.
2 Department of Diabetes & Endocrinology, Countess of Chester Hospital, Chester, UK.
J Med Screen. 2017 Dec;24(4):170-175. doi: 10.1177/0969141316672687. Epub 2016 Nov 3.
Objectives To determine the necessary screening interval for retinopathy in diabetic patients with no retinopathy based on time to laser therapy and to assess long-term visual outcome following screening. Methods In a population-based community screening programme in North Wales, 2917 patients were followed until death or for approximately 12 years. At screening, 2493 had no retinopathy; 424 had mostly minor degrees of non-proliferative retinopathy. Data on timing of first laser therapy and visual outcome following screening were obtained from local hospitals and ophthalmology units. Results Survival analysis showed that very few of the no retinopathy at screening group required laser therapy in the early years compared with the non-proliferative retinopathy group ( p < 0.001). After two years, <0.1% of the no retinopathy at screening group required laser therapy, and at three years 0.2% (cumulative), lower rates of treatment than have been suggested by analyses of sight-threatening retinopathy determined photographically. At follow-up (mean 7.8 ± 4.6 years), mild to moderate visual impairment in one or both eyes due to diabetic retinopathy was more common in those with retinopathy at screening (26% vs. 5%, p < 0.001), but blindness due to diabetes occurred in only 1 in 1000. Conclusions Optimum screening intervals should be determined from time to active treatment. Based on requirement for laser therapy, the screening interval for diabetic patients with no retinopathy can be extended to two to three years. Patients who attend for retinal screening and treatment who have no or non-proliferative retinopathy now have a very low risk of eventual blindness from diabetes.
目的 基于接受激光治疗的时间，确定无视网膜病变的糖尿病患者视网膜病变的必要筛查间隔，并评估筛查后的长期视力结果。方法 在北威尔士一项基于人群的社区筛查项目中，对2917例患者进行随访直至死亡或约12年。筛查时，2493例无视网膜病变；424例主要为轻度非增殖性视网膜病变。首次激光治疗时间和筛查后视力结果的数据来自当地医院和眼科单位。结果 生存分析表明，与非增殖性视网膜病变组相比，筛查时无视网膜病变组在早期很少需要激光治疗（p < 0.001）。两年后，筛查时无视网膜病变组<0.1%需要激光治疗，三年时为0.2%（累积），治疗率低于通过摄影确定的威胁视力的视网膜病变分析所建议的治疗率。随访时（平均7.8 ± 4.6年），筛查时有视网膜病变的患者中，因糖尿病视网膜病变导致一只或两只眼睛出现轻度至中度视力损害更为常见（26%对5%，p < 0.001），但糖尿病导致的失明仅千分之一。结论 应根据开始积极治疗的时间确定最佳筛查间隔。基于激光治疗的需求，无视网膜病变的糖尿病患者的筛查间隔可延长至两到三年。接受视网膜筛查和治疗且无或有非增殖性视网膜病变的患者，最终因糖尿病失明的风险非常低。
