Nicholas A Johnson, Priya Gupta, Terry Lee, Majda Hadziahmetovic, Jullia A Rosdahl
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引用次数: 0
Abstract
Purpose: The utility of screening for early diagnosis of glaucoma remains a widely debated topic in the care of ophthalmic patients. There are currently no population-based guidelines regarding screening for glaucoma. The purpose of this study is to determine the utility of optical coherence tomography (OCT) for early glaucoma screening in a population of diabetic patients. The results of this study may inform future screening practices.
Methods: The current study is a post hoc analysis of OCT data collected from diabetic patients screened for eye disease over 6 months. Glaucoma suspects (GS) were identified based on abnormal retinal nerve fiber layer (RNFL) thickness on OCT. Fundus photographs of GS were graded by two independent raters for vertical cup-to-disc ratio (CDR) and other signs of glaucomatous changes.
Results: Of the 807 subjects screened, 50 patients (6.2%) were identified as GS. The mean RNFL thickness for GS was significantly lower than the mean RNFL in the total screening population (p < .001). Median CDR for GS was 0.44. Twenty-eight eyes of 17 GS were marked as having optic disc notching or rim thinning by at least one grader. Cohen's kappa statistic for inter-rater reliability was 0.85. Racial differences showed that mean CDR was significantly higher in non-whites (p < .001). Older age was associated with thinner RNFL (r = -0.29, p = .004).
Conclusions: Results of this study suggest that in a sample of diabetic patients, a small but clinically significant minority may be flagged as GS based on OCT. Nearly one-third of GS eyes were found to have glaucomatous changes on fundus photography by at least one grader. These results suggest screening with OCT may be useful in detecting early glaucomatous changes in high-risk populations, particularly older, non-white patients with diabetes.
目的：筛查对早期诊断青光眼的作用仍然是眼科患者护理中一个广受争议的话题。目前还没有基于人群的青光眼筛查指南。本研究旨在确定光学相干断层扫描（OCT）在糖尿病患者早期青光眼筛查中的实用性。研究结果可为今后的筛查实践提供参考：本研究是对糖尿病患者在 6 个月内接受眼病筛查所收集的 OCT 数据进行的事后分析。根据 OCT 上异常的视网膜神经纤维层（RNFL）厚度确定青光眼疑似患者（GS）。由两名独立评分员对疑似青光眼患者的眼底照片进行评分，以确定垂直杯盘比（CDR）和其他青光眼变化迹象：结果：在接受筛查的 807 名受试者中，有 50 名患者（6.2%）被确定为 GS。GS患者的平均RNFL厚度明显低于全部筛查人群的平均RNFL厚度（p p r = -0.29, p = .004）：本研究结果表明，在糖尿病患者样本中，有一小部分人可能会根据 OCT 被标记为 GS，但这部分人的临床意义重大。近三分之一的 GS 眼在眼底照相时被至少一名评分员发现有青光眼病变。这些结果表明，用 OCT 进行筛查可能有助于发现高危人群的早期青光眼病变，尤其是老年非白人糖尿病患者。
期刊介绍：
Ophthalmic Epidemiology is dedicated to the publication of original research into eye and vision health in the fields of epidemiology, public health and the prevention of blindness. Ophthalmic Epidemiology publishes editorials, original research reports, systematic reviews and meta-analysis articles, brief communications and letters to the editor on all subjects related to ophthalmic epidemiology. A broad range of topics is suitable, such as: evaluating the risk of ocular diseases, general and specific study designs, screening program implementation and evaluation, eye health care access, delivery and outcomes, therapeutic efficacy or effectiveness, disease prognosis and quality of life, cost-benefit analysis, biostatistical theory and risk factor analysis. We are looking to expand our engagement with reports of international interest, including those regarding problems affecting developing countries, although reports from all over the world potentially are suitable. Clinical case reports, small case series (not enough for a cohort analysis) articles and animal research reports are not appropriate for this journal.
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