Validez de la cámara no midriática en el cribado de la retinopatía diabética y análisis de indicadores de riesgo de la retinopatía

Díaz, M Baeza; Guillén, Vicente Gil; Orozco-Beltrán, Domingo; Carbonell, V. Pedrera; Montes, C Ribera; Pons, Isabel; Martínez-Toldos, J.J.

doi:10.4321/s0365-66912004000900005

Cited by 15 publications

(6 citation statements)

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“…Other methods, more common in primary care, are direct ophthalmoscopy or non-stereoscopic retinography. However, diffuse thickening or thickening in the form of retinal cysts as the initial sign of diabetic macular oedema may go unnoticed with these examination methods, as they can only detect macular oedema from the presence of hard exudates or indirect signs, such as macular haemorrhage or microaneurysms (Aldington et al, 1995; Bursell et al, 2001; Gómez-Ulla et al, 2002; Rudinsky et al, 2002; Herbert, Jordan & Flanagan, 2003; Baeza Diaz et al, 2004; Baeza et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid

Hernández‐Martínez

Palazón‐Bru

Azrak

et al. 2015

PeerJ

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No studies have yet evaluated jointly central foveal thickness (CFT) and the presence of intraretinal fluid (PIF) to diagnose diabetic macular oedema (DMO) using optic coherence tomography (OCT). We performed a cross-sectional observational study to validate OCT for the diagnosis of DMO using both CFT and PIF assessed by OCT (3D OCT-1 Maestro). A sample of 277 eyes from primary care diabetic patients was assessed in a Spanish region in 2014. Outcome: DMO diagnosed by stereoscopic mydriatic fundoscopy. OCT was used to measure CFT and PIF. A binary logistic regression model was constructed to predict the outcome using CFT and PIF. The area under the ROC curve (AUC) of the model was calculated and non-linear equations used to determine which CFT values had a high probability of the outcome (positive test), distinguishing between the presence or absence of PIF. Calculations were made of the sensitivity, specificity, and the positive (PLR) and negative (NLR) likelihood ratios. The model was validated using bootstrapping methodology. A total of 37 eyes had DMO. AUC: 0.88. Positive test: CFT ≥90 µm plus PIF (≥310 µm if no PIF). Clinical parameters: sensitivity, 0.83; specificity, 0.89; PLR, 7.34; NLR, 0.19. The parameters in the validation were similar. In conclusion, combining PIF and CFT provided a tool to very precisely discriminate the presence of DMO. Similar studies are needed to provide greater scientific evidence for the use of PIF in the diagnosis of DMO.

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Section: Introductionmentioning

confidence: 99%

Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid

Hernández‐Martínez

Palazón‐Bru

Azrak

et al. 2015

PeerJ

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“…Estos sistemas presentan varias ventajas, entre ellas, que resultan más económicos, emplean menos tiempo por paciente, pueden ser aplicados a poblaciones físicamente alejadas de los centros de atención especializada y no precisan dilatación pupilar. La fiabilidad de estos sistemas para detectar las alteraciones provocadas por la retinopatía diabética es muy similar a la de los métodos clásicos de exploración retiniana (3)(4)(5). También se ha valorado la concordancia existente entre la interpretación de las imágenes digitales de la retina y la exploración directa de la misma en las consultas de oftalmología y se ha encontrado que en general la correlación entre ambos sistemas es muy 529 alta, lo que avalaría la utilidad del sistema de retinografía no midriática como método de cribado y detección de la retinopatía diabética (6)(7)(8)(9).…”

Section: Discussionunclassified

Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de familia

Andonegui

Berástegui

Serrano³

et al. 2008

Arch Soc Esp Oftalmol

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RESUMENObjetivo: Determinar la concordancia en la interpretación de retinografías no midriáticas de pacientes diabéticos entre oftalmólogos y un grupo de médicos de atención primaria previamente sometidos a un proceso de adiestramiento.Métodos: El estudio fue dividido en dos fases. En la primera se adiestró a los participantes en la interpretación de imágenes retinográficas. La segunda fase se realizó sobre 1000 imágenes correspondientes a 200 pacientes, 100 sin retinopatía diabética y 100 con retinopatía. Los participantes debían decidir si las imágenes presentaban o no signos de retinopatía diabética. Para la valoración de la concordancia se utilizó el índice kappa. Se estimó como adecuado un porcentaje de desacuerdo del 15% con una precisión del 5% (±5%) con un nivel de confianza del 95%.Resultados: El porcentaje de diagnósticos coincidentes entre oftalmólogos y médicos de atención primaria está entre 89 y 97,5%. Por lo que respecta ARTÍCULO ORIGINAL ABSTRACT Purpose: To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training. Methods: The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (±5%) with a confidence level of 95% was considered adequate. Results: The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index

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“…Screening for diabetic retinopathy or diabetic macular oedema in primary care centres is performed using non-stereoscopic retinography (photographic colour images to control the progression of fundus of the eye abnormalities). However, diffuse thickening or thickening in the form of retinal cysts as the initial sign of diabetic macular oedema may go unnoticed using this method, as it only allows the detection of macular oedema in the presence of hard exudates, macular haemorrhage or microaneurysms ( Gómez-Ulla et al, 2002 ; Baeza Diaz et al, 2004 ; Baeza et al, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

External validation of cut-off points for foveal thickness taking into account the intraretinal fluid using optical coherence tomography to diagnose diabetic macular oedema

Hernández‐Martínez

Palazón‐Bru

Azrak

et al. 2017

PeerJ

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BackgroundIn late 2015, cut-off points were published for foveal thickness to diagnose diabetic macular oedema taking into account the presence of intraretinal fluid using optical coherence tomography (OCT) in primary care patients (90 µm in the presence of intraretinal fluid and 310 µm otherwise).MethodsThis cross-sectional observational study was carried out on 134 eyes of diabetic patients treated in specialised ophthalmology services in a Spanish region in 2012–2013, to externally validate the aforementioned cut-off points. The main variable (Clinical Standard) was the diagnosis of macular oedema through indirect ophthalmoscopy and posterior segment slit-lamp biomicroscopy. As validation variables, both the foveal thickness and the presence of intraretinal fluid obtained by OCT were used. Validation was performed using bootstrapping by calculating the area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR).ResultsForty-one eyes presented diabetic macular oedema (30.6%). The bootstrapping validation parameters were: AUC, 0.88; sensitivity, 0.75; specificity, 0.95; PLR, 14.31; NLR, 0.26. These values were very similar to those of the original publication.ConclusionWe have externally validated in specialised care patients the cut-off points published for the diagnosis of diabetic macular oedema. We suggest that others carry out validation studies in their communities.

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Validez de la cámara no midriática en el cribado de la retinopatía diabética y análisis de indicadores de riesgo de la retinopatía

Cited by 15 publications

References 0 publications

Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid

Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid

Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de familia

External validation of cut-off points for foveal thickness taking into account the intraretinal fluid using optical coherence tomography to diagnose diabetic macular oedema

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