非扩瞳眼底摄影作为间接检眼镜筛查社区糖尿病视网膜病变的替代方法：印度农村和部落地区的一项比较性试点研究。
Non-mydriatic fundus photography as an alternative to indirect ophthalmoscopy for screening of diabetic retinopathy in community settings: a comparative pilot study in rural and tribal India.
机构信息
Divyajyoti Trust, Surat, Gujarat, India
Retina Department, Divyajyoti Trust, Surat, Gujarat, India.
出版信息
BMJ Open. 2022 Apr 8;12(4):e058485. doi: 10.1136/bmjopen-2021-058485.
OBJECTIVES
The impending and increasing prevalence of diabetic retinopathy (DR) in India has necessitated a need for affordable and valid community outreach screening programme for DR, especially in rural and far to reach indigenous local communities. The present study is a pilot study aimed to compare non-mydriatic fundus photography with indirect ophthalmoscopy for its utilisation as a feasible and logistically convenient screening modality for DR in an older age, rural, tribal population in Western India.
DESIGN AND SETTING
This community-based, cross-sectional, prospective population study was a part of a module using Rapid Assessment of Avoidable Blindness and DR methodology in 8340 sampled participants with ≥50 years age. In this study, the diabetics identified were screened for DR using two methods: non-mydriatic fundus photography on the field by trained professionals, that were then graded by a retina specialist at the base hospital and indirect ophthalmoscopy by expert ophthalmologists in the field with masking of each other's findings for its utility and comparison.
RESULTS
The prevalence of DR, sight threatening DR and maculopathy using indirect ophthalmoscopy was found to be 12.1%, 2.1% and 6.6%, respectively. A fair agreement (κ=0.48 for DR and 0.59 for maculopathy) was observed between both the detection methods. The sensitivity and specificity of fundus photographic evaluation compared with indirect ophthalmoscopy were found to be 54.8% and 92.1% (for DR), 60.7% and 90.8% (for any DR) and 84.2% and 94.8% (for only maculopathy), respectively.
CONCLUSION
Non-mydriatic fundus photography has the potential to identify DR (any retinopathy or maculopathy) in community settings in Indian population. Its utility as an affordable and logistically convenient cum practical modality is demonstrable. The sensitivity of this screening modality can be further increased by investing in better resolution cameras, capturing quality images and training and validation of imagers.
TRIAL REGISTRATION NUMBER
CTRI/2020/01/023025; Clinical Trial Registry, India (CTRI).
目的
印度即将出现并日益增多的糖尿病视网膜病变（DR）患病率，需要一种负担得起且有效的社区外展筛查计划来筛查 DR，尤其是在农村和偏远的土著社区。本研究是一项试点研究，旨在比较免散瞳眼底摄影和间接检眼镜在印度西部老年农村部落人群中的应用，评估其作为 DR 可行且在后勤上方便的筛查方式的潜力。
设计和设置
这是一项基于社区的横断面前瞻性人群研究，是使用快速评估可避免盲和 DR 方法在 8340 名≥50 岁样本参与者中进行的一个模块的一部分。在本研究中，通过受过培训的专业人员在现场使用免散瞳眼底摄影对识别出的糖尿病患者进行 DR 筛查，然后由基地医院的视网膜专家对其进行分级，并由现场的眼科专家使用间接检眼镜进行检查，彼此的发现结果相互屏蔽，以评估其效用并进行比较。
结果
间接检眼镜发现 DR、威胁视力的 DR 和黄斑病变的患病率分别为 12.1%、2.1%和 6.6%。两种检测方法之间观察到良好的一致性（DR 的κ值为 0.48，黄斑病变的κ值为 0.59）。与间接检眼镜相比，眼底照相评估的敏感性和特异性分别为 54.8%和 92.1%（DR）、60.7%和 90.8%（任何 DR）以及 84.2%和 94.8%（仅黄斑病变）。
结论
免散瞳眼底摄影有可能在印度人群的社区环境中发现 DR（任何视网膜病变或黄斑病变）。它作为一种负担得起且在后勤上方便实用的方式具有实用性。通过投资于更好分辨率的相机、拍摄高质量的图像以及对成像者进行培训和验证，可以进一步提高这种筛查方式的敏感性。
临床试验注册号
CTRI/2020/01/023025；印度临床试验注册中心（CTRI）。
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