Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Ophthalmol. 2022 Feb 10;7(1):e000915. doi: 10.1136/bmjophth-2021-000915. eCollection 2022.
To evaluate the diagnostic accuracy of teleretinal screening compared with face-to-face examination for detection of diabetic retinopathy (DR) and age-related macular degeneration (AMD).
This study adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). A comprehensive search of OVID MEDLINE, EMBASE and Cochrane CENTRAL was performed from January 2010 to July 2021. QUADAS-2 tool was used to assess methodological quality and applicability of the studies. A bivariate random effects model was used to perform the meta-analysis. Referrable DR was defined as any disease severity equal to or worse than moderate non-proliferative DR or diabetic macular oedema (DMO).
28 articles were included. Teleretinal screening achieved a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (0.74 to 0.95) for any DR (13 studies, n=7207, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) low). Accuracy for referrable DR (10 studies, n=6373, GRADE moderate) was lower with a sensitivity of 0.88 (0.81 to 0.93) and specificity of 0.86 (0.79 to 0.90). After exclusion of ungradable images, the specificity for referrable DR increased to 0.95 (0.90 to 0.98), while the sensitivity remained nearly unchanged at 0.85 (0.76 to 0.91). Teleretinal screening achieved a sensitivity of 0.71 (0.49 to 0.86) and specificity of 0.88 (0.85 to 0.90) for detection of AMD (three studies, n=697, GRADE low).
Teleretinal screening is highly accurate for detecting any DR and DR warranting referral. Data for AMD screening is promising but warrants further investigation.
CRD42020191994.
评估远程视网膜筛查与面对面检查在诊断糖尿病视网膜病变（DR）和年龄相关性黄斑变性（AMD）中的诊断准确性。
本研究遵循系统评价和诊断测试准确性研究的首选报告项目（PRISMA-DTA）。从 2010 年 1 月到 2021 年 7 月，对 OVID MEDLINE、EMBASE 和 Cochrane CENTRAL 进行了全面检索。使用 QUADAS-2 工具评估研究的方法学质量和适用性。使用双变量随机效应模型进行荟萃分析。可转诊 DR 定义为任何严重程度等于或大于中度非增殖性 DR 或糖尿病性黄斑水肿（DMO）的疾病。
共纳入 28 篇文章。远程视网膜筛查对任何 DR（13 项研究，n=7207，推荐分级、评估、发展和评估（GRADE）低）的敏感性为 0.91（95%CI：0.82 至 0.96），特异性为 0.88（0.74 至 0.95）。对可转诊 DR（10 项研究，n=6373，GRADE 中等）的准确性较低，敏感性为 0.88（0.81 至 0.93），特异性为 0.86（0.79 至 0.90）。排除不可分级图像后，可转诊 DR 的特异性提高至 0.95（0.90 至 0.98），而敏感性几乎不变，为 0.85（0.76 至 0.91）。远程视网膜筛查对 AMD（三项研究，n=697，GRADE 低）的敏感性为 0.71（0.49 至 0.86），特异性为 0.88（0.85 至 0.90）。
远程视网膜筛查对检测任何 DR 和需要转诊的 DR 非常准确。AMD 筛查的数据很有希望，但需要进一步研究。
PROSPERO 注册号：CRD42020191994。
