Kleinstein R N, Roseman J M, Herman W H, Holcombe J, Louv W C
School of Optometry, University of Alabama, Birmingham 35294.
J Am Optom Assoc. 1987 Nov;58(11):879-82.
Optometrists examined 25 eyes with varying severity of diabetic retinopathy. No history or clinical information was provided to the optometrists who performed fundus examinations on dilated eyes using direct or indirect ophthalmoscopes. Color stereoscopic fundus photographs were independently graded and used as the standard. Optometrists made a correct diagnosis of whether retinopathy was present in 77% of the eyes (95% confidence interval (CI): 73%, 82%). They made a correct diagnosis of the type and degree of diabetic retinopathy in 57% of the eyes (95% CI: 39%, 75%). This diagnosis rate exceeded the rate reported for physician examiners (39%) and equaled that of general ophthalmologists (52%) in the only other similar study. Sensitivity for diagnosis of diabetic retinopathy in eyes of diabetic patients using only ophthalmoscopy was 74% (95% CI: 67%, 81%), while specificity for diagnosis of the absence of retinopathy was 84% (95% CI: 73%, 96%). 100% of these optometrists would have referred the eye with preproliferative retinopathy. 53% would have referred the eye classified as proliferative retinopathy without high risk characteristics, and 79% would have referred the eye with macular edema.
验光师检查了25只患有不同严重程度糖尿病视网膜病变的眼睛。在使用直接或间接检眼镜对散瞳后的眼睛进行眼底检查时，没有向验光师提供任何病史或临床信息。彩色立体眼底照片由独立人员分级，并用作标准。验光师对77%的眼睛（95%置信区间（CI）：73%，82%）是否存在视网膜病变做出了正确诊断。他们对57%的眼睛（95%CI：39%，75%）的糖尿病视网膜病变类型和程度做出了正确诊断。在唯一一项其他类似研究中，这一诊断率超过了内科医生检查者报告的比率（39%），与普通眼科医生的比率（52%）相当。仅使用检眼镜诊断糖尿病患者眼睛中糖尿病视网膜病变的敏感性为74%（95%CI：67%，81%），而诊断无视网膜病变的特异性为84%（95%CI：73%，96%）。这些验光师中有100%会转诊患有增殖前期视网膜病变的眼睛。53%会转诊被归类为无高危特征的增殖性视网膜病变的眼睛，79%会转诊患有黄斑水肿的眼睛。
