Division of Cardiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland.
Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland.
J Feline Med Surg. 2021 Oct;23(10):921-927. doi: 10.1177/1098612X20983265. Epub 2021 Jan 13.
Systemic hypertension (SHT) causes severe target organ damage (TOD) and blood pressure (BP) measurement should be routine in at-risk populations. Fundoscopy is a tool to corroborate acute clinical relevance of high BP results and to decide on immediate therapy. Not every cat with a high BP result can be examined by an ophthalmologist. The study objective was to determine the reliability of fundoscopy in cats with SHT performed by a veterinarian without ophthalmology specialty training.
Cats with suspicion of hypertensive TOD or belonging to an at-risk population for SHT with a first measurement of elevated BP >160 mmHg were enrolled. Indirect ophthalmoscopy was performed by a recent graduate veterinarian followed by a veterinary ophthalmologist. Confirmation of SHT was based on two additional sets of systolic BP measurements >160 mmHg by Doppler sphygmomanometry.
Thirty-three cats were included. SHT was confirmed in 27 cats. SHT was detected on routine examinations in 12/27 cats; fundoscopic lesions were observed in 9/12 by the non-trained veterinarian and in 11/12 by an ophthalmologist. Nine of 27 cats were neurological patients; fundoscopic lesions were detected in 4/9 by the non-trained veterinarian and in 7/9 by an ophthalmologist. Six of 27 cats were presented for acute blindness; fundus lesions were detected in all six cats by the non-trained veterinarian and ophthalmologist. SHT was not confirmed and fundoscopic lesions were not detected by either examiner in 6/33 cats. Compared with a veterinary ophthalmologist, reliability of detecting fundus abnormalities by the non-trained veterinarian was 72% (13/18) for cats with, and 100% (6/6) for cats without, vision.
Fundus examination by a non-specialty trained veterinarian has reasonably high reliability for the detection of ocular TOD. Private practice veterinarians are encouraged to perform an initial fundic examination in suspected hypertensive cats.
全身性高血压（SHT）可导致严重的靶器官损伤（TOD），应在高危人群中常规测量血压（BP）。眼底检查是一种工具，可以证实高血压结果的急性临床相关性，并决定是否立即进行治疗。并非每只血压升高的猫都可以由眼科医生进行检查。本研究的目的是确定未经眼科专业培训的兽医在患有 SHT 的猫中进行眼底检查的可靠性。
纳入怀疑患有高血压 TOD 或属于高血压高危人群且首次测量血压升高>160mmHg 的猫。间接眼底镜检查由最近毕业的兽医进行，然后由兽医眼科医生进行。根据多普勒血压计测量的另外两组收缩压>160mmHg，确认存在 SHT。
共纳入 33 只猫。27 只猫确诊为 SHT。27 只猫中，有 12 只在常规检查中发现 SHT；未经培训的兽医在 9/12 只猫中观察到眼底病变，而眼科医生在 11/12 只猫中观察到眼底病变。27 只猫中有 9 只为神经科患者；未经培训的兽医在 4/9 只猫中检测到眼底病变，而眼科医生在 7/9 只猫中检测到眼底病变。27 只猫中有 6 只为急性失明；未经培训的兽医和眼科医生均在所有 6 只猫中发现眼底病变。在 33 只猫中，有 6 只既未确诊 SHT，也未发现眼底病变，无论是兽医还是眼科医生均未发现眼底病变。与兽医眼科医生相比，非专业兽医检测眼底异常的可靠性对于有视力的猫为 72%（13/18），对于无视力的猫为 100%（6/6）。
未经专业培训的兽医进行眼底检查对于检测眼部 TOD 具有相当高的可靠性。鼓励私人执业兽医在疑似高血压猫中进行初步眼底检查。
