Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California.
Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California; Department of Ophthalmology, LAC+USC Medical Center, Los Angeles, California.
Ophthalmol Glaucoma. 2023 May-Jun;6(3):247-254. doi: 10.1016/j.ogla.2022.10.007. Epub 2022 Nov 1.
To evaluate rates and risk factors associated with follow-up adherence to in-person glaucoma evaluations and confirmed glaucoma diagnosis in glaucoma suspects identified through teleretinal diabetic retinopathy screening (TDRS).
Retrospective cohort study SUBJECTS: Patients with diabetes identified through teleretinal screening to have large or asymmetric cup-to-disc ratios in a Los Angeles County safety-net primary care-based TDRS program.
Retrospective chart review was performed to obtain demographic and clinical information for patients with cup-to-disc ratios concerning for glaucoma on TDRS. Patients who completed an in-person follow-up appointment within 1 year of teleretinal screening were adherent. Factors associated with follow-up adherence and diagnosis of glaucoma were analyzed with chi-square and independent t tests along with multivariable logistic regressions.
The proportion of patients with suspected glaucoma who adhered with in-person follow-up examination, proportion of patients with confirmed glaucoma diagnosis, and factors associated with follow-up adherence and glaucoma diagnosis.
Eight-hundred seventeen patients with optic discs suspicious for glaucoma were included. Five-hundred thirty-four (65.4%) patients successfully completed an in-person glaucoma evaluation. Among these patients, 62.9% and 24.5% received a diagnosis of glaucoma suspect and glaucomatous optic neuropathy, respectively. Compared with patients aged < 50 years, patients aged 50 to 64 years had 1.57 times higher odds of being adherent with in-person visits (P = 0.036), whereas no difference was seen in those aged ≥ 65 years. For every $10 000 increase in the zip code median income, patients had 11% lower odds of being adherent (P = 0.031). Compared with Latino patients, Black patients had 3.52 times (P < 0.001) higher odds of having confirmed glaucoma.
The majority of patients referred as glaucoma suspects on TDRS completed a follow-up examination, and nearly a quarter of those examined received a confirmed glaucoma diagnosis. Patients aged ≥ 50 and < 65 years along with those from lower-income neighborhoods were more likely to follow up for an in-person evaluation. Compared with Latino patients, Black patients had a higher risk for a confirmed glaucoma diagnosis. This demonstrates the effectiveness of glaucoma detection in a large-scale TDRS program for a safety-net patient population.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
评估通过远程视网膜糖尿病筛查（TDRS）发现的青光眼疑似患者接受面对面青光眼评估和确诊青光眼诊断的随访依从率，以及相关的风险因素。
回顾性队列研究。
在洛杉矶县初级保健为基础的 TDRS 计划中，通过远程视网膜筛查发现杯盘比异常的糖尿病患者。
对 TDRS 筛查发现的杯盘比异常的患者进行回顾性图表审查，以获取人口统计学和临床信息。在 TDRS 筛查后 1 年内完成面对面随访预约的患者被认为是依从的。采用卡方检验和独立 t 检验以及多变量逻辑回归分析，评估与随访依从性和青光眼诊断相关的因素。
疑似青光眼患者中接受面对面随访检查的比例、确诊青光眼诊断的比例，以及与随访依从性和青光眼诊断相关的因素。
共纳入 817 例疑似青光眼患者。534 例（65.4%）患者成功完成了面对面青光眼评估。在这些患者中，62.9%和 24.5%分别被诊断为青光眼疑似患者和青光眼性视神经病变。与<50 岁的患者相比，50 至 64 岁的患者接受面对面就诊的可能性高 1.57 倍（P=0.036），而≥65 岁的患者则无差异。每个邮政编码中位数收入增加 10000 美元，患者的依从性降低 11%（P=0.031）。与拉丁裔患者相比，黑人患者的确诊青光眼的可能性高 3.52 倍（P<0.001）。
大多数在 TDRS 上被转诊为青光眼疑似患者的患者完成了随访检查，其中近四分之一的患者接受了确诊青光眼诊断。≥50 岁且<65 岁的患者以及来自低收入社区的患者更有可能接受面对面评估。与拉丁裔患者相比，黑人患者确诊青光眼的风险更高。这表明在大规模 TDRS 计划中，对初级保健患者人群进行青光眼检测是有效的。
作者没有与本文讨论的材料相关的专有或商业利益。
