Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Eye (Lond). 2024 Mar;38(4):698-706. doi: 10.1038/s41433-023-02754-y. Epub 2023 Sep 20.
The validity of findings from epidemiological studies using self-report of ophthalmic conditions depends on several factors. We assessed the diagnostic accuracy of self-reported age-related macular degeneration (AMD) among older Australians enroled in a primary prevention clinical trial and compared diagnostic accuracy between demographic subgroups.
At baseline (2010-2015), Australian sub-study participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial, underwent bilateral two-field, 45° non-mydriatic colour retinal photography. Beckman classification of any-stage AMD was used as the reference standard diagnosis. Participants were asked whether a doctor had ever diagnosed them with "macular degeneration" (the index test) via a paper-based questionnaire as part of the ASPREE Longitudinal Study of Older Persons (ALSOP) within the first year of enrolment.
In total, 4193 participants were included (aged 70-92 years, 50.8% female). Of those, 262 (6.3%) reported having AMD and 92 (2.2%) were unsure. Retinal grading detected 2592 (61.8%) with no AMD, 867 (20.7%) with early, 686 (16.4%) with intermediate and 48 (1.1%) with late AMD (n = 1601 with any-stage AMD, 38.2%). Self-reported AMD had 11.4% sensitivity (95% CI 9.9-13.1) and 96.9% specificity (95% CI 96.2-97.6) for any-stage AMD, with 69.8% and 63.9% positive and negative predictive values. Sensitivity was higher among participants with late-stage AMD (87.5%), older participants (26.8%), and those with poorer vision (41.0%).
Although most participants with late-stage AMD were aware of having AMD, the majority with early and intermediate AMD were not. Therefore, findings from studies that rely on disease self-report should be interpreted with caution.
使用眼科疾病自我报告进行流行病学研究的结果有效性取决于多个因素。我们评估了参加初级预防临床试验的澳大利亚老年人中自我报告的年龄相关性黄斑变性（AMD）的诊断准确性，并比较了不同人群亚组之间的诊断准确性。
在基线（2010-2015 年），ASPREE 试验的澳大利亚子研究参与者接受了双侧 2 野、45°非散瞳彩色视网膜摄影。贝克曼分类的任何阶段 AMD 被用作参考标准诊断。参与者在入组后的第一年通过纸质问卷作为 ASPREE 老年人纵向研究（ALSOP）的一部分，被问及医生是否曾诊断过他们患有“黄斑变性”（索引测试）。
共有 4193 名参与者入选（年龄 70-92 岁，50.8%为女性）。其中，262 名（6.3%）报告患有 AMD，92 名（2.2%）不确定。视网膜分级检测到 2592 名（61.8%）无 AMD，867 名（20.7%）为早期 AMD，686 名（16.4%）为中期 AMD，48 名（1.1%）为晚期 AMD（n=1601 名任何阶段 AMD，占 38.2%）。自我报告的 AMD 对任何阶段 AMD 的敏感性为 11.4%（95%CI9.9-13.1），特异性为 96.9%（95%CI96.2-97.6），阳性预测值和阴性预测值分别为 69.8%和 63.9%。晚期 AMD 参与者（87.5%）、年龄较大的参与者（26.8%）和视力较差的参与者（41.0%）的敏感性更高。
尽管大多数晚期 AMD 参与者都知道自己患有 AMD，但大多数早期和中期 AMD 患者并不知道。因此，依赖疾病自我报告的研究结果应谨慎解释。
