| Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy. | |
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MedLine Citation:
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PMID: 11702969 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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S Prasad; G G Kamath; K Jones; L G Clearkin; R P Phillips |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Eye (London, England) Volume: 15 ISSN: 0950-222X ISO Abbreviation: Eye (Lond) Publication Date: 2001 Oct |
Date Detail:
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Created Date: 2001-11-12 Completed Date: 2001-12-11 Revised Date: 2009-11-03 |
Medline Journal Info:
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Nlm Unique ID: 8703986 Medline TA: Eye (Lond) Country: England |
Other Details:
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Languages: eng Pagination: 595-601 Citation Subset: IM |
Affiliation:
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Department of Ophthalmology, Arrowe Park Hospital, Upton, Wirral, UK. sprasad@rcsed.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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