北京农村居民白内障筛查流程的探讨

Preliminary study of cataract screening flow chart in rural Beijing population

目的通过免散瞳数码眼底照相在农村居民白内障筛查的应用,探讨农村白内障筛查流程的可行性。设计人群横断面研究。研究对象北京农村参加合作医疗的55～80岁居民约52万人。方法2008年7～11月对北京10个涉农区县进行了以白内障为主的眼病筛查。由各区县卫生局组织,在视力检查和慢性病问卷调查后,对低视力(生活视力)者应用免散瞳数码眼底照相机进行眼前节和眼底照相,图像上传到浏览器/服务器(B/S)构架的数据库,由专业人员集中阅片,并做出白内障、需白内障手术和其他眼病的诊断。主要指标低视力及需白内障手术者的人数。结果目标人群中建立眼科电子病历43.5万份(应答率83.6%)。发现低视力患者约4.6万人,行眼前节及眼底照相21383人。发现白内障患者12441人,占照相者的58.14%。需手术的白内障患者4623人,占照相者的21.60%。除白内障以外,还发现了其他眼科疾病,并得到了慢性病的资料。结论50岁以上农村居民在低视力筛查后,以数码眼底照相机免散瞳眼前节和眼底照相筛查白内障的流程不仅具有简单、快速的优点,且可实现多种致盲眼病联合筛查。

Objective To assess the validity of a digital nonmydriatic fundus photography in detecting cataract and to investigate the feasibility of cataract screening flow chart in rural Beijing population. Design Population-based cross-sectional study. Participants 520000 rural resident of 55-80 years old took part in cooperative medical care in Beijing. Methods We performed cataract screening from July 2008 to Nov. 2008 in 10 agriculture-related suburban counties. Municipal Health Bureau organized the screening. After sireple visual acuity test and questionnaire of chronic diseases, nonmydriatic anterior segment and fundus photographs were taken in those with low vision. All images were uploaded to the special B/S database in the internet. Professionals read all photos in a photo center and made cataract and other eye disease diagnosis. Main Outcome Measures The number of patients with low vision, and the number of needing cataract operation. Results 435000 electronic medical records were set up in target population of 520000 and the response rate was 83.6%. Among 46000 subjects with low vision, nonmydriatic anterior segment and fundus photographs were taken in 21383 subjects, 12441 subjects were diagnozed as cataract （accounted for 58.14% of subjects with photos）. In all patients with cataract, 4623 patients needed cataract surgery, accounted for 21.60% of subjects with photos. In addition, other eye diseases and chronic diseases data were collected. Conclusion Cataract screening flow chart in rural Beijing people based on low vision screening and nonmydriatic fundus photography not only has the advantages of quick and easy, but also realizes the united screening of other blinding eye diseases. （Ophthalmol CHN, 2009, 18： 80-83）