Coelho-Costa Inês, Silva-Pereira Amanda, Mota-Moreira Pedro, Marques-Couto Pedro, Teixeira-Martins Rita, Maia Carolina, Falcão Manuel, Laiginhas Rita
Ophthalmology Department, Local Health Unit of São João, 4099-450 Porto, Portugal.
Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
J Clin Med. 2025 May 12;14(10):3344. doi: 10.3390/jcm14103344.
: Diabetic retinopathy (DR) is the leading cause of preventable blindness among working-age adults. Early detection through screening programs is essential for managing the condition and preventing visual impairment. In Portugal, the national DR screening program (DR SP) targets diabetic patients, aiming to detect DR at an early stage and refer patients requiring intervention for an ophthalmology appointment. This study aims to assess the effectiveness of the Portuguese DR SP by analyzing patients referred for a hospital appointment following a positive screening result. : An observational retrospective cohort study was conducted at Unidade Local de Saúde de São João (ULS-SJ), including patients referred to a DR SP hospital appointment between January 2020 and December 2023. Data were collected from hospital records upon approval by the Hospital Ethics Committee. Screening and hospital diagnoses were compared for agreement. The Chi-Square test and Cohen's Kappa were used to assess the association between screening and hospital diagnoses. : A total of 1126 patients (2251 retinographies) were analyzed. The median time from screening to hospital consultation was 63 days (Interquartile Range = 39-99), though referral times varied widely within the same classifications (ranging from 8 to 354 days). The most common screening classifications were R2 (pre-proliferative DR, 47.8%) and M1 (maculopathy, 24.6%). In eyes with DR, agreement between screening and hospital diagnoses was highest for R2 (40.1%) and M1 (32.3%), while proliferative DR (R3) showed 30% agreement. The positive predictive value (PPV) of the screening program was 55.9%, with a false positive rate of 44.1%. A statistically significant association between screening and hospital diagnoses was observed ( < 0.001, Chi-Square test), though Cohen's Kappa values (0.167 Right Eye, 0.157 Left eye) indicated only slight agreement. : Our study found that DR SP effectively identifies patients needing ophthalmologic evaluation with moderate diagnostic agreement and a relatively high false positive rate, leading to unnecessary referrals. While this ensures that sight-threatening cases are not missed, improvements in grader training, classification protocols, and Optical Coherence Tomography (OCT) integration could improve results. Strengthening screening adherence and optimizing referral pathways would further improve the program's impact on early DR detection and management.
糖尿病视网膜病变（DR）是工作年龄成年人可预防失明的主要原因。通过筛查项目进行早期检测对于控制病情和预防视力损害至关重要。在葡萄牙，国家糖尿病视网膜病变筛查项目（DR SP）针对糖尿病患者，旨在早期检测出DR，并将需要干预的患者转介至眼科就诊。本研究旨在通过分析筛查结果呈阳性后被转介至医院就诊的患者来评估葡萄牙DR SP的有效性。：在圣若昂当地卫生单位（ULS-SJ）进行了一项观察性回顾性队列研究，纳入了2020年1月至2023年12月期间被转介至DR SP医院就诊的患者。经医院伦理委员会批准后，从医院记录中收集数据。比较筛查结果与医院诊断结果的一致性。使用卡方检验和科恩kappa系数来评估筛查与医院诊断之间的关联。：共分析了1126例患者（2251份视网膜图像）。从筛查到医院会诊的中位时间为63天（四分位间距 = 39 - 99天），尽管在相同分类中，转诊时间差异很大（范围为8至354天）。最常见的筛查分类为R2（增殖前期DR，47.8%）和M1（黄斑病变，24.6%）。在患有DR的眼中，筛查与医院诊断结果的一致性在R2中最高（40.1%），在M1中为32.3%，而增殖性DR（R3）的一致性为30%。筛查项目的阳性预测值（PPV）为55.9%，假阳性率为44.1%。观察到筛查与医院诊断之间存在统计学显著关联（<0.001，卡方检验），尽管科恩kappa系数值（右眼为0.167，左眼为0.157）仅表明一致性一般。：我们的研究发现，DR SP能够有效识别需要眼科评估的患者，诊断一致性中等，但假阳性率相对较高，导致不必要的转诊。虽然这确保了不会漏诊威胁视力的病例，但在分级人员培训、分类方案和光学相干断层扫描（OCT）整合方面的改进可以改善结果。加强筛查依从性和优化转诊途径将进一步提高该项目对早期DR检测和管理的影响。
