Arej N, Antoun J, Waked R, Saab C, Saleh M, Waked N
Département d'ophtalmologie, faculté de médecine, Université Saint-Joseph de Beyrouth, Liban.
Département d'ophtalmologie, faculté de médecine, Université Saint-Joseph de Beyrouth, Liban.
J Fr Ophtalmol. 2019 Mar;42(3):288-294. doi: 10.1016/j.jfo.2018.12.005. Epub 2019 Mar 8.
Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Non-mydriatic fundus photography (NMFP) has been adopted as a screening tool for this disease. We aim to determine the prevalence of DR through this method in Lebanese diabetic patients and to evaluate the impact of such screening in this population.
This study explores data from an awareness and screening campaign conducted in Lebanon. Diabetic patients from multiple regions were referred by their endocrinologists to undergo NMFP using the Optomed SmartScope handheld fundus camera. Photographs were interpreted by a remote observer, and recommendations were given accordingly. The prevalence of DR was calculated, and statistical analyses were performed on the clinical characteristics, fundus findings and number of referrals to ophthalmologists.
The campaign lasted 11 months, during which 2205 patients were examined in 37 screening locations. Out of the 97.41% of patients with type 2 diabetes mellitus, 12.56% had signs of DR, with no significant difference between the regions. 6.28% of the photos were uninterpretable. Positive results were associated with a longer duration of diabetes (P<0.01), treatment with insulin (P<0.01), as well as the presence and chronicity of systemic hypertension (P=0.01). 25% of patients with positive testing were retrospectively asked about their follow-up; only one third had an ophthalmologic examination as per the recommendation, among whom 68.18% underwent treatment for proliferative DR and/or diabetic macular edema.
Tele-ophthalmology is useful in mass screening for DR. The importance of dilated fundus examinations still needs to be highlighted for diabetic patients, and better collaboration between endocrinologists and ophthalmologists is required to improve screening outcomes.
糖尿病视网膜病变（DR）是全球失明的主要原因。非散瞳眼底照相术（NMFP）已被用作该疾病的筛查工具。我们旨在通过这种方法确定黎巴嫩糖尿病患者中DR的患病率，并评估这种筛查对该人群的影响。
本研究探讨了在黎巴嫩开展的一项宣传与筛查活动的数据。多个地区的糖尿病患者由其内分泌科医生转诊，使用Optomed SmartScope手持式眼底相机进行非散瞳眼底照相。照片由远程观察员解读，并据此给出建议。计算DR的患病率，并对临床特征、眼底检查结果以及转诊至眼科医生的数量进行统计分析。
该活动持续了11个月，在此期间，在37个筛查地点对2205名患者进行了检查。在2型糖尿病患者中，97.41%的患者中，12.56%有DR体征，各地区之间无显著差异。6.28%的照片无法解读。阳性结果与糖尿病病程较长（P<0.01）、使用胰岛素治疗（P<0.01）以及系统性高血压的存在和慢性程度（P=0.01）相关。对25%检测呈阳性的患者进行了回顾性随访；只有三分之一的患者按照建议进行了眼科检查，其中68.18%的患者接受了增殖性DR和/或糖尿病性黄斑水肿的治疗。
远程眼科在DR的大规模筛查中很有用。对于糖尿病患者，仍需强调散瞳眼底检查的重要性，并且内分泌科医生和眼科医生之间需要更好地合作以改善筛查结果。
