Harding S P, Broadbent D M, Neoh C, White M C, Vora J
St Paul's Eye Unit, Royal Liverpool University Hospital.
BMJ. 1995 Oct 28;311(7013):1131-5. doi: 10.1136/bmj.311.7013.1131.
To evaluate different methods for community based screening for sight threatening diabetic eye disease.
Prospective study.
Mobile screening unit visiting inner city community clinics; hospital assessment clinic (tertiary centre).
395 diabetic patients registered with four general practices in an inner city location.
Community based photography with mydriasis and direct ophthalmoscopy through dilated pupils by an experienced ophthalmologist, both compared with reference standard of slit lamp biomicroscopy by a consultant specialist in medical retinal disease.
Sensitivity and specificity of screening method and prevalence of sight threatening diabetic eye disease (moderate preproliferative retinopathy, circinate maculopathy, exudate within 1 disc diameter of fixation, other diabetes related eye disease).
358 subjects underwent photography, 326 attended hospital clinic for ophthalmoscopy, and six were ungradable on photographs and biomicroscopy, leaving 320 for analysis. Of these 295 (91%) attended clinic within four months of photography. Sensitivity of detection of eye disease by photography was 89% (95% confidence interval 80% to 98%), significantly better than for direct ophthalmoscopy (65% (51% to 79%)). Analysis of patients with false negative results indicated possible improvement of photographic sensitivity to 93% by addition of stereoscopic macular pair photographs. Specificity of detection of sight threatening eye disease was 86% (82% to 90%) for photography and 97% (95% to 99%) for direct ophthalmoscopy.
Since high sensitivity is essential for an effective screening programme, a photographic method should be considered as preferred option in national, community based screening programmes. Even in the hands of an experienced ophthalmologist, direct ophthalmoscopy is limited by weaknesses inherent to the instrument.
评估基于社区的威胁视力的糖尿病眼病筛查的不同方法。
前瞻性研究。
流动筛查单位走访市中心社区诊所；医院评估诊所（三级中心）。
在市中心一个地点的四家全科诊所登记的395名糖尿病患者。
由经验丰富的眼科医生进行散瞳后的社区摄影以及通过散瞳瞳孔进行直接检眼镜检查，二者均与医学视网膜疾病顾问专家进行的裂隙灯生物显微镜检查的参考标准进行比较。
筛查方法的敏感性和特异性以及威胁视力的糖尿病眼病（中度增殖前期视网膜病变、环状黄斑病变、在注视点1个视盘直径范围内的渗出物、其他糖尿病相关眼病）的患病率。
358名受试者接受了摄影，326人到医院诊所接受检眼镜检查，6人在照片和生物显微镜检查中无法分级，剩余320人用于分析。其中295人（91%）在摄影后四个月内到诊所就诊。摄影检测眼病的敏感性为89%（95%置信区间80%至98%），显著优于直接检眼镜检查（65%（51%至79%））。对假阴性结果患者的分析表明，通过增加立体黄斑对照片，摄影敏感性可能提高到93%。检测威胁视力眼病的特异性，摄影为86%（82%至90%），直接检眼镜检查为97%（95%至99%）。
由于高敏感性对于有效的筛查计划至关重要，在全国性基于社区的筛查计划中，应考虑将摄影方法作为首选。即使在经验丰富的眼科医生手中，直接检眼镜检查也受到该仪器固有弱点的限制。
