Document Detail


Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy.
MedLine Citation:
PMID:  11702969     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To assess the effectiveness of optometrists as screeners for diabetic retinopathy using slit-lamp binocular indirect ophthalmoscopy through dilated pupils. METHODS: Prospective study of a screening scheme. Screening was performed by 27 locally accredited optometrists in their practice. The referral protocol used a new simple grading system of retinopathy, especially designed for use in an optometrist screening programme. All positive referrals and 10% of negative referrals were reexamined by an ophthalmologist. Sensitivity, specificity, likelihood ratios and technical failure rates were calculated. RESULTS: The optometrists screened 4904 people with diabetes in 18 months. 'Subthreshold' (screen negative) reports accounted for 4438 (90.5% of 4904); 429 (9.67%) of these were re-examined at secondary screening. There was disagreement regarding grading in 13 patients, of whom 5 (1.16% of 429) had sight-threatening retinopathy (STDR); this extrapolates to 52 patients if all the 4438 test-negatives had been examined. Of the 371 'threshold' patients, 112 (30.18%) were false positives; the commonest cause for false positive referral was drusen in patients with background diabetic retinopathy. The sensitivity for identification of STDR was 76% (95% CI 70% to 81%) and specificity 95% (95% CI 95% to 96%). The likelihood ratio of a positive test indicating STDR was 16.54 (95% CI 14.17 to 19.23) and that of a negative test 0.25 (95% CI 0.20 to 0.32). The technical failure rate was 0.2%. CONCLUSIONS: Suitably trained and accredited community optometrists performed well when screening for diabetic retinopathy using slit-lamp biomicroscopy through a dilated pupil. This was facilitated by the use of simple grading and referral criteria. The sensitivity, positive likelihood ratio and specificity were high.
Authors:
S Prasad; G G Kamath; K Jones; L G Clearkin; R P Phillips
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Eye (London, England)     Volume:  15     ISSN:  0950-222X     ISO Abbreviation:  Eye (Lond)     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-11-12     Completed Date:  2001-12-11     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8703986     Medline TA:  Eye (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  595-601     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology, Arrowe Park Hospital, Upton, Wirral, UK. sprasad@rcsed.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Accreditation
Adolescent
Adult
Aged
Clinical Protocols
Diabetic Retinopathy / diagnosis*
Female
Humans
Likelihood Functions
Male
Mass Screening / standards*
Middle Aged
Optometry / education,  standards*
Prospective Studies
Referral and Consultation
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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