Wang F, Tielsch J M, Ford D E, Quigley H A, Whelton P K
Worthen Center for Eye Care Research, Georgetown University, Washington, DC.
Ophthalmic Epidemiol. 1998 Jun;5(2):69-82. doi: 10.1076/opep.5.2.69.1575.
Screening in a primary care setting could be an effective method for detection of eye disease. This study was designed to evaluate a questionnaire and a battery of tests for their performance in eye disease screening at a primary care clinic.
405 patients aged 40 years or older were interviewed and received a comprehensive eye examination including visual acuity and visual field testing, tonometry, slit-lamp examination, dilated fundus examination and photography. Sensitivity and specificity for the identification of eye disease were calculated for each test and various combinations of tests.
A questionnaire-based algorithm for detection of overall eye disease was sufficiently sensitive (90%) but less specific (44%) than an ideal screening test. Distance visual acuity with presenting correction of < or = 20/40 had a sensitivity of 61% and specificity of 72%. A dilated fundus examination had a sensitivity of 79% and specificity of 82%. In screening for glaucoma, tonometry was ineffective (sensitivity = 27% and specificity = 96%), while visual field testing by suprathreshold screening had a sensitivity of 70% and specificity of 67%. Among a variety of combinations, a two-stage strategy with the questionnaire as a first-stage and visual acuity and ophthalmoscopy as second-stage tests provided the best balance of sensitivity (83%) and specificity (76%).
Among currently available ophthalmic tests, an eye examination including a thorough fundus examination is critical in detection of eye disease. A five-item questionnaire may be useful to identify patients at high risk in primary care practice. More effective tests are needed to improve performance of eye disease screening.
在基层医疗环境中进行筛查可能是检测眼部疾病的有效方法。本研究旨在评估一份问卷和一系列测试在基层医疗诊所眼部疾病筛查中的表现。
对405名40岁及以上的患者进行了访谈，并接受了全面的眼部检查，包括视力和视野测试、眼压测量、裂隙灯检查、散瞳眼底检查和摄影。计算了每项测试以及各种测试组合识别眼部疾病的敏感性和特异性。
基于问卷的总体眼部疾病检测算法敏感性足够高（90%），但特异性低于理想筛查测试（44%）。矫正后远视力≤20/40的敏感性为61%，特异性为72%。散瞳眼底检查的敏感性为79%，特异性为82%。在青光眼筛查中，眼压测量无效（敏感性=27%，特异性=96%），而阈上筛查视野测试的敏感性为70%，特异性为67%。在各种组合中，以问卷为第一阶段，视力和检眼镜检查为第二阶段测试的两阶段策略在敏感性（83%）和特异性（76%）之间提供了最佳平衡。
在目前可用的眼科检查中，包括彻底眼底检查的眼部检查对检测眼部疾病至关重要。一份五项问卷可能有助于在基层医疗实践中识别高危患者。需要更有效的测试来提高眼部疾病筛查的表现。
