免散瞳数码眼底照相在老年眼底病中的筛查价值

Screening value of non-mydriatic digital fundus photography in elderly fundus diseases

目的探讨免散瞳数码眼底照相在老年眼底病中的筛查价值。方法选取我院行体检或视力检查的200例可疑眼底病的老年患者,均行无免散瞳数码眼底照相检查和荧光素眼底血管造影检查。分析老年眼底病与年龄、相关疾病等的相关性,并以糖尿病视网膜病变为例,统计免散瞳数码眼底照相筛查的敏感性和特异性等。结果 200例患者共筛出8种眼底病和116例眼底病患者,其中糖尿病性视网膜病变例数最多,其次为视网膜动脉硬化、年龄相关性黄斑变性,三种常见眼底病筛查准确率依次为100%、96.00%、94.74%。年龄>65岁、糖尿病、脑梗死及具有视网膜血管性病变家族史、青光眼家族史的老年眼底病患者占比显著高于非眼底病者(P<0.05)。免散瞳数码眼底照相筛查老年糖尿病性视网膜病变的敏感性为83.33%,特异性为95.24%,Youden指数为0.78,Kappa值为0.81(>0.61)。结论免散瞳数码眼底照相筛查老年眼底病尤其是糖尿病视网膜病变准确率高,可大范围开展筛查,且费用低,临床可重点筛查高龄、合并糖尿病、脑梗死及具有家族史的患者。

To investigate the screening value of non-mydriatic digital fundus photography in elderly fundus diseases.Two hundred patients with suspected fundus diseases who underwent physical examination or examination of visual acuity in our hospital were selected as study subjects.All patients underwent non-mydriatic digital fundus photography and fundus fluorescein angiography.The screening results were statistically analyzed,and the correlation between elderly fundus diseases and age as well as related diseases was analyzed.Taking diabetic retinopathy as an example,the screening sensitivity and specificity of non-mydriatic digital fundus photography were analyzed.Among the 200 patients,there were 8 kinds of fundus diseases and 116 patients with fundus diseases.Of the patients,diabetic retinopathy was more than other types of fundus diseases(P<0.05),followed by retinal arteriosclerosis and age-related macular degeneration.The accuracy rates in screening the three kinds of the common fundus diseases were 100.0%,96.0%,and 94.7%respectively.Older than 65 years,diabetes,cerebral infarction,and family history of retinal vascular diseases and glaucoma occupied higher proportions in patients with fundus disease than patients without fundus diseases(P<0.05).The sensitivity,specificity and Youden index of non-mydriatic digital fundus photography in screening the elderly diabetic retinopathy were 83.33%,95.24%and 0.78,respectively.The Kappa=0.81(>0.61)indicated a high degree of consistency.The accuracy rate of non-mydriatic digital fundus photography in screening the elderly fundus diseases,especially diabetic retinopathy,is high.It can be used in wide range,and the costs are low.Attention should be paid to screen the elderly,patients with diabetes,cerebral infarction or family history.