Zhou Wan, Yuan Xiao-Jing, Li Jie, Wang Wei, Zhang Hao-Qiang, Hu Yuan-Yuan, Ye Shan-Dong
Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China.
Department of Endocrinology, Anhui Provincial Hospital, Affiliated to Anhui Medical University, Hefei 230001, Anhui Province, China.
World J Diabetes. 2024 Feb 15;15(2):251-259. doi: 10.4239/wjd.v15.i2.251.
Early screening and accurate staging of diabetic retinopathy (DR) can reduce blindness risk in type 2 diabetes patients. DR's complex pathogenesis involves many factors, making ophthalmologist screening alone insufficient for prevention and treatment. Often, endocrinologists are the first to see diabetic patients and thus should screen for retinopathy for early intervention.
To explore the efficacy of non-mydriatic fundus photography (NMFP)-enhanced telemedicine in assessing DR and its various stages.
This retrospective study incorporated findings from an analysis of 93 diabetic patients, examining both NMFP-assisted telemedicine and fundus fluorescein angiography (FFA). It focused on assessing the concordance in DR detection between these two methodologies. Additionally, receiver operating characteristic (ROC) curves were generated to determine the optimal sensitivity and specificity of NMFP-assisted telemedicine, using FFA outcomes as the standard benchmark.
In the context of DR diagnosis and staging, the kappa coefficients for NMFP-assisted telemedicine and FFA were recorded at 0.775 and 0.689 respectively, indicating substantial intermethod agreement. Moreover, the NMFP-assisted telemedicine's predictive accuracy for positive FFA outcomes, as denoted by the area under the ROC curve, was remarkably high at 0.955, within a confidence interval of 0.914 to 0.995 and a statistically significant -value of less than 0.001. This predictive model exhibited a specificity of 100%, a sensitivity of 90.9%, and a Youden index of 0.909.
NMFP-assisted telemedicine represents a pragmatic, objective, and precise modality for fundus examination, particularly applicable in the context of endocrinology inpatient care and primary healthcare settings for diabetic patients. Its implementation in these scenarios is of paramount significance, enhancing the clinical accuracy in the diagnosis and therapeutic management of DR. This methodology not only streamlines patient evaluation but also contributes substantially to the optimization of clinical outcomes in DR management.
糖尿病视网膜病变（DR）的早期筛查和准确分期可降低2型糖尿病患者的失明风险。DR复杂的发病机制涉及多种因素，仅靠眼科医生进行筛查不足以进行预防和治疗。内分泌科医生通常是最早诊治糖尿病患者的，因此应该对视网膜病变进行筛查以便早期干预。
探讨非散瞳眼底照相（NMFP）增强远程医疗在评估DR及其不同阶段中的疗效。
这项回顾性研究纳入了对93例糖尿病患者的分析结果，同时检查了NMFP辅助远程医疗和眼底荧光血管造影（FFA）。重点评估这两种方法在DR检测中的一致性。此外，以FFA结果作为标准基准，生成受试者操作特征（ROC）曲线以确定NMFP辅助远程医疗的最佳敏感性和特异性。
在DR诊断和分期方面，NMFP辅助远程医疗和FFA的kappa系数分别记录为0.775和0.689，表明两种方法之间存在高度一致性。此外，ROC曲线下面积显示，NMFP辅助远程医疗对FFA阳性结果的预测准确性非常高，为0.955，置信区间为0.914至0.995，且统计学意义上的P值小于0.001。该预测模型的特异性为100%，敏感性为90.9%，约登指数为0.909。
NMFP辅助远程医疗是一种实用、客观且精确的眼底检查方式，尤其适用于糖尿病患者的内分泌科住院护理和基层医疗环境。在这些场景中实施该方法具有至关重要的意义，可提高DR诊断和治疗管理的临床准确性。这种方法不仅简化了患者评估，还对优化DR管理的临床结果有很大贡献。
