Clinic-Based Eye Disease Screening Using Non-Expert Fundus Photo Graders at the Point of Screening: Diagnostic Validity and Yield
| Autor: | Jason S Melo, Somanguan Ausayakhun, Atitaya Apivatthakakul, Jeremy D. Keenan, Sakarin Ausayakhun, Blake M. Snyder, Onnisa Nanegrungsunk, Chanusnun Narongchai |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Intraocular pressure Visual acuity genetic structures Eye Diseases Eye disease Visual Acuity Glaucoma Fundus (eye) Diagnostic Techniques Ophthalmological Slit Lamp Microscopy Cataract 03 medical and health sciences Macular Degeneration 0302 clinical medicine Vision Screening Ophthalmology medicine Photography Humans Prospective Studies Mass screening Intraocular Pressure 030304 developmental biology Aged 0303 health sciences Diabetic Retinopathy medicine.diagnostic_test Ophthalmologists business.industry Fundus photography Reproducibility of Results Diabetic retinopathy Middle Aged medicine.disease eye diseases Ophthalmoscopy Physician Assistants 030221 ophthalmology & optometry Female sense organs Clinical Competence medicine.symptom business |
| Zdroj: | American journal of ophthalmology. 227 |
| ISSN: | 1879-1891 |
| Popis: | Purpose The intent of this study was to determine the diagnostic accuracy of several diagnostic tests for age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, and cataract, as well as the proportions of patients with eye disease from each of 3 enrolling clinics. Design Diagnostic accuracy study. Methods Patients ≥50 years old in a diabetes, thyroid, and general medicine clinic were screened using visual acuity, tonometry, and fundus photography. Photographs were graded at the point-of-screening by non-ophthalmic personnel. Participants with positive screening test results in either eye and a 10% random sample with negative results in both eyes were referred for an in-person, reference-standard ophthalmology examination. Results Of 889 participants enrolled, 229 participants failed at least 1 test in either eye, of which 189 presented for an ophthalmic examination. An additional 76 participants with completely normal screening test results were referred for examination, of which 50 attended. Fundus photography screening had the highest yield for DR (sensitivity: 67%; 95% confidence interval [CI]: 39%-87%), visual acuity screening for cataract (sensitivity: 89%; 95% CI: 86%-92%), and intraocular pressure screening for glaucoma or suspected glaucoma (sensitivity: 25%; 95% CI: 14%-40%). The burden of disease was relatively high in all 3 clinics, with at least 1 of the diseases of interest (ie, AMD, DR, glaucoma or suspected glaucoma, or cataract) detected in 25% of participants (95% CI: 17-35%) from the diabeteses clinic, 34% (95% CI: 22%-49%) from the thyroid clinic, and 21% (95% CI: 13%-32%) from the general clinic. Conclusions Non-expert eye disease screening in health clinics may be a useful model for detection of eye disease in resource-limited settings. |
| Databáze: | OpenAIRE |
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