2011-2012年广东省汕头市社区视力检查对提高白内障手术率的促进

Impact of community visual test on cataract surgery rate of Shantou in Guangdong Province from 2011 to 2012

目的评估2011-2012年广东省汕头市社区视力检查对提高白内障手术率(CSR)的影响。设计横断面研究。研究对象汕头市390个社区参加视力检查的50岁以上者14 370人。方法 2个工作组(分别由经培训的1名护士及1名行政人员组成)前往汕头市金平区、龙湖区、澄海区、潮阳区(居民总数约248万)33个街道390个社区居委会或老年人活动中心,对50岁以上者(约62.79万)采用标准对数视力表检查远视力。行政人员负责组织受试者,护士负责视力检查。小孔视力≤0.3者,建议其到汕头国际眼科中心门诊,由专项负责医师用裂隙灯、眼底镜等进一步检查,对矫正视力≤0.3、眼压<22 mm Hg、晶状体混浊且无手术禁忌证的白内障患者提供手术治疗,其他眼病则由相应专科予相应治疗。统计2011年8月23日～2012年8月22日数据结果与上一年同期汕头国际眼科中心白内障手术量进行比较,分析未参加社区视力检查、未来院就诊、未行手术治疗的人数及比例。主要指标社区未参与检查的白内障患者数与潜在的白内障手术储备量。结果 2011-2012年为390个社区50岁以上者14 370人进行了视力检查,应答率为2.29%。小孔视力≤0.3者3753人(26.12%),其中1990人(53.02%)到汕头国际眼科中心就诊。1360人(68.34%)确诊为白内障,行白内障手术807例(59.34%);仍有61.35万(97.71%)50岁以上者未参加社区视力检查,估计约16.02万人(26.12%)小孔视力≤0.3,其中约7.53万人(46.98%)不会选择来汕头国际眼科中心就诊,可能来就诊的8.49万人(53.02%)中约5.80万(68.34%)白内障患者,约2.36万(40.68%)人不会选择手术治疗。此次视力检查项目使汕头国际眼科中心白内障手术量较上一年额外增加807例,即可使检查地区的CSR增加达325.40例(807/2.48)。结论广东省汕头市白内障患者储备量大,社区视力检查对CSR的提高有促进作用,但仍有约半数低视力者未遵从到医院就诊的建议,至少三分之一的白内障患者未接受手术建议,原因有待于进一步研究。

Objective To estimate the impact of visual test on improving cataract surgery rate （CSR） in communities of Shantou in Guangdong Province from 2011 to 2012. Design cross-sectional study. Participants 14 370 people aged 50 years or over from 390 com- munities in Shantou. Methods Visual test were performed among senior people aged 50 years or over in Shantou communities by 4 trained staffs from 2 working teams （one nurse and one administrator as one working team） of Joint Shantou International Eye Center （JSIEC） at community committee or senior center. The administrator was responsible for organization and the nurse was in charge of vi- sual test. Participants with pinhole-corrected vision ≤ 0.3 （Standard for logarithmic visual acuity chart） were stlggested to JSIEC to take further examinations including slit-lamp, funduscopy by the certain doctors who were responsible for this item. The part of people with best corrected visual acuity ≤ 0.3, intraocular pressure 〈22 mm Hg, lens opacity, diagnosed cataract and without surgical eontraindica- tion were offered cataract surgery. The other people with other diseases were treated by specialized departments. The number of cataract surgeries in JSIEC from August 23, 2011 to August 22, 2012 was compared with the surgery number from last year at the same period. At last, the number and the rate of people who didn＇t come to take visual test or didn＇t come to our center or didn＇t have cataract surgery were analyzed to estimate its potential impact on improving the CSR. Main Outcome Measures The number and the rate of people with cataract who didn＇t come to take the visual test and the potential reserves of cataract surgery. Results From 2011 to 2012, 14 370 （2.29%） of 627 900 people aged 50 years or over had a visual test in communities where the total population is about 2.48 mil- lion. Of which, 3753 （26.1%） people were suggested to JSIEC because of probable cataract. 1360 （68.3%） of 1990 patients who came to JSIEC were diagnosed cataract. 807 （59.3%） of them had eventually underwent cataract surgery. However, there are still 613 500 （97.71%） senior people including 160 200 people would have pinhole-corrected vision ~〈0.3 didn＇t enter the community visual test. 75 300（46.98%） of them would not come to JSIEC. There would have 58 000 （68.34%） cataract patients in the people who would come to JSIEC. Even- tually, 23 600 （40.68%） patients would not undergo cataract surgery. Compared to last year, the number of cataract surgeries in JSIEC increased by 807 which means the CSR in these 390 communities can increase by 325.4 after the action. Conclusion There are still a certain number of cataract patients in Shantou, Guangdong province. The community visual test is simple, easy to carry out, and it can improve CSR of community areas, even in the urban district. However, there is about half of participants with pinhole-corrected vision ≤ 0.3 didn＇t follow the referring suggestion, and about 40% patients with cataract didn＇t follow the cataract surgery suggestion, which need to be further studied. （Ophthalmol CHN, 2013, 22： 239-243）