Clinic-based eye disease screening employing non-expert fundus photo-graders at the point of screening: diagnostic validity and yield.
to determine the diagnostic accuracy of several diagnostic tests for AMD, DR, glaucoma, and cataract, as well as the proportion with eye disease from each of three enrolling clinics.Diagnostic accuracy study.Patients ≥ 50 years of age in a diabetes, thyroid, and general medicine clinic were screened with visual acuity, tonometry, and fundus photography. Photographs were graded at the point-of-screening by non-ophthalmic personnel. Participants with a positive screening test in either eye, as well as a 10% random sample with negative results in both eyes, were referred for an in-person, reference-standard ophthalmology exam.Of 889 participants enrolled, 229 failed at least one test in either eye, of which 189 presented for an ophthalmologist examination. An additional 76 participants with completely normal screening test results were referred for examination, of which 50 attended. Fundus photography screening had the highest yield for DR (sensitivity 67%, 95%CI 39% to 87%), visual acuity screening for cataract (sensitivity 89%, 95%CI 86% to 92%) and intraocular pressure screening for glaucoma/glaucoma suspect (sensitivity 25%, 95%CI 14% to 40%). The burden of disease was relatively high in all three clinics, with at least one of the diseases of interest (i.e., AMD, DR, glaucoma/glaucoma suspect, or cataract) detected in 25% (95%CI 17-35%) of participants from the diabetic clinic, 34% (95%CI 22-49%) from the thyroid clinic, and 21% (13-32%) from the general clinic.Non-expert eye disease screening in health clinics may be a useful model for detection of eye disease in resource-limited settings.
Authors: Somanguan Ausayakhun, Blake M Snyder, Sakarin Ausayakhun, Onnisa Nanegrungsunk, Atitaya Apivatthakakul, Chanusnun Narongchai, Jason S Melo, Jeremy D Keenan