非散瞳眼底相机筛查糖尿病视网膜病变的诊断准确性：巴基斯坦一项基于医院的观察性研究。

Diagnostic accuracy of non-mydriatic fundus camera for screening of diabetic retinopathy: A hospital based observational study in Pakistan.

作者信息

Fahadullah Muhammad, Memon Nasir Ahmed, Salim Sumaira, Ahsan Shahid, Fahim Muhammad Faisal, Mumtaz Seema Nigah, Shaikh Sikander Ali, Memon Muhammad Saleh

机构信息

Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Ophthalmology Karachi, Pakistan.

出版信息

J Pak Med Assoc. 2019 Mar;69(3):378-382.

PMID:30890831

Abstract

OBJECTIVE

To determine the diagnostic accuracy of non-mydriatic fundus camera for the detection of diabetic retinopathy.

METHODS

The cross-sectional study was conducted at Al Ibrahim Eye Hospital, Karachi, from January to May 2015, and comprised patients with type 2 diabetes who were screened for diabetic retinopathy. Single 45° fundus image focussed at macula was obtained and labelled using non-mydriatic fundus camera by a trained optometrist. Photos were labelled as positive (diabetic retinopathy present), negative (no diabetic retinopathy) or unreadable. The pupil was then dilated and fundi were examined by ophthalmologist with slit-lamp and fundus lens. Results of fundus examination were labelled as positive, negative or invisible/indecisive. Results of ophthalmologist were taken as the standard reference to evaluate sensitivity and speci?city for detecting diabetic retinopathy with non-mydriatic fundus camera. SPSS 20 was used for data analysis.

RESULTS

Total eyes screened numbered 2970 related to 1485 patients. Diabetic retinopathy was found in 646(21.8%) eyes, 485(20.9%) photographs were unreadable and 1839(57.3%) were normal. Ophthalmologist on slit lamp bio-microscopy labelled 736(25%) eyes as positive for diabetes retinopathy, 335(15%) as indecisive and 1899(60%) as normal. The sensitivity of non-mydriatic fundus camera was 400/556 (72%) while specificity was 1548/1794 (86.3%). Positive predictive value and negative predictive value were 400/646 (62%) and 1548/1704 (90%) respectively. The level of agreement was moderate (k=0.0551) for optometrist compared to ophthalmologist. False positive diagnosis by optometrist numbered 78/1839 (4.24%) and false negative was 123/646(19%).

CONCLUSIONS

Non-mydriatic fundus camera was found to be a reliable screening tool for detecting and referral diabetic retinopathy cases to ophthalmologist for further evaluation and management.

摘要

目的

确定免散瞳眼底相机检测糖尿病视网膜病变的诊断准确性。

方法

2015年1月至5月在卡拉奇的易卜拉欣眼科医院进行了一项横断面研究，纳入2型糖尿病患者并对其进行糖尿病视网膜病变筛查。由一名经过培训的验光师使用免散瞳眼底相机获取并标记一张聚焦于黄斑的45°眼底单图像。照片被标记为阳性（存在糖尿病视网膜病变）、阴性（无糖尿病视网膜病变）或不可读。然后散瞳，由眼科医生使用裂隙灯和眼底镜检查眼底。眼底检查结果被标记为阳性、阴性或不可见/不确定。以眼科医生的检查结果作为标准参考，评估免散瞳眼底相机检测糖尿病视网膜病变的敏感性和特异性。使用SPSS 20进行数据分析。

结果

共筛查了1485例患者的2970只眼。646只眼（21.8%）发现有糖尿病视网膜病变，485张照片（20.9%）不可读，1839张照片（57.3%）正常。眼科医生通过裂隙灯生物显微镜检查将736只眼（25%）标记为糖尿病视网膜病变阳性，335只眼（15%）标记为不确定，1899只眼（60%）标记为正常。免散瞳眼底相机的敏感性为400/556（72%），特异性为1548/1794（86.3%）。阳性预测值和阴性预测值分别为400/646（62%）和1548/1704（90%）。与眼科医生相比，验光师的一致性水平为中等（k = 0.0551）。验光师的假阳性诊断为78/1839（4.24%），假阴性为123/646（19%）。