Verhoeven S, van Ballegooie E, Crijns H, Hylkema H A, Loeve A A, Casparie A F
Afd. Interne Geneeskunde, Ziekenhuis De Weezenlanden, Zwolle.
Ned Tijdschr Geneeskd. 1993 Aug 21;137(34):1713-7.
To determine the value of a screening programme with fundus photography for diabetic retinopathy in diabetes mellitus type II patients.
Prospective.
General practices in the region Zwolle, The Netherlands.
650 Patients from 50 general practices were photographed after dilating both eyes. Of these 215 were examined by an ophthalmologist. Data of patients who did not join the study were analysed in 13 general practices. Any symptom of retinopathy and/or photographs of poor quality implied referral to an ophthalmologist.
Of a total of 1300 photographs 208 (16%) could hardly or not at all be assessed. The agreement in the group of 215 patients between photography and ophthalmoscopy was statistically significant at classification level (Cohen's kappa 0.41). The advice given to patients after photography did not differ from that after ophthalmoscopy (kappa: 0.50); photography did not miss any high-risk characteristics, it yielded more warnings, and underestimated the level of retinopathy in 8 out of 215 cases. With current ophthalmologic rates in the Netherlands fundus photography was not financially advantageous as 71 (33%) out of 215 patients needed to be referred to an ophthalmologist. However, in the other 144 (67%) patients photography sufficed. This may offer a solution where ophthalmic care is in short supply. Of 168/420 patients who did not apply for photography 116 (69%) were either under ophthalmic supervision already or too disabled to be screened.
The use of a fundus camera is equivalent to funduscopy by an ophthalmologist in screening for retinopathy of type II diabetic patients. There are no financial benefits, but it reduces the work load of ophthalmologists.
确定眼底照相筛查方案对2型糖尿病患者糖尿病视网膜病变的价值。
前瞻性研究。
荷兰兹沃勒地区的普通诊所。
对来自50家普通诊所的650例患者进行双眼散瞳后照相。其中215例患者由眼科医生进行检查。在13家普通诊所分析未参与研究患者的数据。任何视网膜病变症状和/或质量不佳的照片均意味着需转诊至眼科医生处。
在总共1300张照片中，208张（16%）几乎无法或完全无法评估。在215例患者组中，照相与检眼镜检查之间的一致性在分类水平上具有统计学意义（科恩kappa系数为0.41）。照相后给患者的建议与检眼镜检查后并无差异（kappa系数：0.50）；照相未遗漏任何高危特征，发出了更多警示，并且在215例病例中有8例低估了视网膜病变程度。按照荷兰目前的眼科诊疗率，眼底照相在经济上并无优势，因为215例患者中有71例（33%）需要转诊至眼科医生处。然而，在其他144例（67%）患者中，照相就足够了。这可能为眼科护理供应短缺的情况提供一种解决方案。在未申请照相的168/420例患者中，116例（69%）要么已经在接受眼科监测，要么因身体过于残疾而无法进行筛查。
在筛查2型糖尿病患者的视网膜病变方面，使用眼底相机等同于眼科医生进行的检眼镜检查。虽无经济收益，但可减轻眼科医生的工作量。
