Schachat A P, Hyman L, Leske M C, Connell A M, Hiner C, Javornik N, Alexander J
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.
Arch Ophthalmol. 1993 Aug;111(8):1064-70. doi: 10.1001/archopht.1993.01090080060019.
To compare the use of clinical examination and fundus photograph gradings in detecting diabetic retinopathy in a population that includes persons with and without diabetes.
Population-based epidemiologic study.
Sir Winston Scott Polyclinic, Bridgetown, Barbados, West Indies.
Subset of a random sample of the country's population aged 40 to 86 years.
Among 1168 black persons with fundus photograph evaluations, ophthalmologic examinations, diabetes history, and glycated hemoglobin data, 21% reported a history of diabetes; 9.5% had definite diabetes (glycated hemoglobin > 11.5%); and 13.3% had a diabetes history and glycated hemoglobin value less than or equal to 11.5%. The frequency of diabetic retinopathy in this group was 7.7% (90/1168) by clinical examination, 8.7% (102/1168) by photograph gradings, and 6.7% (78/1168) by both methods.
These results suggest that in certain populations that include diabetics and nondiabetics, a clinical examination by an ophthalmologist will detect most cases of diabetic retinopathy identified by disc and macula photographs read by skilled graders. However, it will lead to an underestimate of prevalence. Staff availability and cost, issues not examined in this study, should determine which approach is selected.
比较临床检查和眼底照片分级在检测糖尿病视网膜病变方面的应用，该人群包括糖尿病患者和非糖尿病患者。
基于人群的流行病学研究。
西印度群岛巴巴多斯布里奇敦温斯顿·斯科特综合诊所。
该国40至86岁随机抽样人群的一个子集。
在1168名有眼底照片评估、眼科检查、糖尿病病史和糖化血红蛋白数据的黑人中，21%报告有糖尿病病史；9.5%患有确诊糖尿病（糖化血红蛋白>11.5%）；13.3%有糖尿病病史且糖化血红蛋白值小于或等于11.5%。通过临床检查，该组糖尿病视网膜病变的发生率为7.7%（90/1168），通过照片分级为8.7%（102/1168），两种方法均检测出的为6.7%（78/1168）。
这些结果表明，在某些包含糖尿病患者和非糖尿病患者的人群中，眼科医生进行的临床检查能检测出熟练分级人员通过视盘和黄斑照片识别出的大多数糖尿病视网膜病变病例。然而，这会导致患病率被低估。本研究未探讨的人员可用性和成本问题，应决定选择哪种方法。
