Valoración del uso de retinografía como método de diagnóstico precoz de glaucoma crónico en atención primaria: validación para el cribado en población con factores de riesgo para glaucoma de ángulo abierto / Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors

Objetivo: Determinar la exactitud y el comportamiento de las retinografías realizadas en atención primaria como herramienta de diagnóstico precoz del glaucoma crónico (GAA) en población con factores de riesgo. Diseño: Estudio observacional, descriptivo y transversal con 2 observadores en paralelo de forma ciega: 2 médicos de atención primaria (MAP) y un oftalmólogo de atención especializada Emplazamiento: Centro de atención primaria urbano, consultas externas del servicio de oftalmología (hospitalario). Participantes: Ciento noventa y seis pacientes de ambos sexos, entre 40-70 años, diabéticos, hipertensos, no diagnosticados de glaucoma, captados mediante llamada telefónica tras revisión de listados de pacientes. Dos de los pacientes no acudieron a las citaciones para las pruebas oftalmológicas, considerándose como pérdidas. Mediciones: Para la variable cuantitativa diagnóstico de glaucoma por retinografía: exactitud calculada por la sensibilidad y especificidad, comportamiento por los valores predictivos positivo y negativo, cociente de probabilidad positivo y negativo, concordancia interobservador por índices kappa y cociente de correlación intraclase (CCI). Resultados: Se obtuvo una sensibilidad del 21% (IC 95%: 0-43%), especificidad del 93% (IC 95%: 89-97%), valor predictivo negativo del 94% (IC 95%: 90-97%) y positivo del 20% (IC 95%: 0-40%); cociente de probabilidad positivo de 3,07 (IC 95%: 0,98-9,62) y negativo de 0,84 (IC 95%: 0,64-1,11). El CCI fue de 0,653 (IC 95%: 0,495-0,769), y el índice kappa, de 0,140 (ET: 0,106). Conclusiones: La retinografía no presenta un comportamiento adecuado como herramienta de diagnóstico precoz de GAA desde atención primaria según el modelo planteado en nuestro estudio. Serían necesarios ajustes que subsanasen su baja sensibilidad, como usar otras pruebas combinadas y mejorar el entrenamiento de los MAP (AU)

Objective: The aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG). Design: An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist. Location: Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic. Participants: A total of 196 patients of both genders, between 40-70 years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses. Measurements: For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC). Results: The retinography for OAG screening has a sensitivity of 21% (95% CI: 0-43%), a specificity of 93% (95% CI: 89-97%), a negative predictive value of 94% (95% CI: 90-97%), and positive of 20% (95% CI: 0-40%); positive probability ratio of 3.07 (95% CI: 0.98-9.62) and negative 0.84 (95% CI: 0.64-1.11). The IC was 0.653 (95% CI: 0.495-0.769) and kappa index of 0.140 (0.106 ET). Conclusions: According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved (AU)

[Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors]. / Valoración del uso de retinografía como método de diagnóstico precoz de glaucoma crónico en atención primaria: validación para el cribado en población con factores de riesgo para glaucoma de ángulo abierto.

OBJECTIVE: The aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG). DESIGN: An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist. LOCATION: Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic. PARTICIPANTS: A total of 196 patients of both genders, between 40-70years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses. MEASUREMENTS: For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC). RESULTS: The retinography for OAG screening has a sensitivity of 21% (95%CI: 0-43%), a specificity of 93% (95%CI: 89-97%), a negative predictive value of 94% (95%CI: 90-97%), and positive of 20% (95%CI: 0-40%); positive probability ratio of 3.07 (95%CI: 0.98-9.62) and negative 0.84 (95%CI: 0.64-1.11). The IC was 0.653 (95%CI: 0.495-0.769) and kappa index of 0.140 (0.106ET). CONCLUSIONS: According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved.

[Validation of the electronic mailing of retinographs of diabetic patients in order to detect retinopathy in primary care]. / Validación de la transmisión por correo electrónico de la retinografía de pacientes diabéticos para detectar retinopatía en atención primaria.

OBJECTIVE: Evaluate concordance in biomicroscopy evaluation of diabetic retinopathy degree among ophthalmologists. Validation of e-mail transmission of digital fundus photographs of type 2 diabetes patients as a method of diabetic retinopathy detection. DESIGN: Descriptive study. SETTING: Urban, primary health centre, and hospital. PARTICIPANTS: Type 2 diabetic patients selected of consecutive form when going to the primary health center (n=352). MAIN MEASUREMENTS: Parallel observer-blind evaluation of degree of retinopathy through biomicroscopy performed by ophthalmologists, against digital photographic images sent by e-mail taken by the family doctors. Concordance in the biomicroscopy among ophthalmologists was previously tested. RESULTS: Retinopathy was revealed in 25.70% of the retinographs; 10.44% was mild, 12.05% moderate, and 3.21% severe. Weighted kappa was 0.876 for biomicroscopy concordance. Sensitivity in detecting retinopathy is 76.6% and specificity 95.2%; 92.7% and 99.5% for ophthalmologist-derivable retinopathy. Sensitivity was 66.7% for non-mydriatic retinograph without dilation, 76.9% with elective dilation, and 85% with the mydriatic. CONCLUSIONS: Concordance in evaluation of retinopathy degree through biomicroscopy was "very good." This allows using a single ophthalmologist's exploration as a reference model. E-mail transmission of the photograph of the back of the eye in type 2 diabetic patients as a retinopathy detection method is feasible. Regardless of the type of retinograph used, the photographs should be taken on the dilated eye, as this significantly improves sensitivity.

Validación de la transmisión por correo electrónico de la retinografía de pacientes diabéticos para detectar retinopatía en atención primaria / Validation of the electronic mailing of retinographs of diabetic patients in order to detect retinopathy in primary care

Objetivo. Evaluar la concordancia de la biomicroscopia de los pacientes diabéticos tipo 2 entre oftalmólogos, y analizar la validez de la transmisión por correo electrónico de la fotografía del fondo de ojo de pacientes diabéticos tipo 2, para detectar retinopatía diabética. Diseño. Observacional, descriptivo. Emplazamiento. Centro de salud y hospital urbanos. Participantes. Pacientes diabéticos tipo 2 seleccionados de forma consecutiva al acudir al centro de salud (n = 352). Mediciones principales. Valoración en paralelo, de forma ciega para los observadores, del grado de retinopatía mediante biomicroscopia realizada por oftalmólogos, frente a imagen fotográfica digital realizada por el médico de familia enviada por correo electrónico. Previamente se comprobó la concordancia entre oftalmólogos en la biomicroscopia. Resultados. El 25,70% de las retinografías mostraron retinopatía: el 10,44%, leve; el 12,05%, moderada, y el 3,21%, severa. El análisis de la concordancia en la biomicroscopia mostró un valor kappa ponderado de 0,876. La sensibilidad para detectar retinopatía es del 76,6% y la especificidad del 95,2%; que son del 92,7% y el 99,5%, respectivamente, para retinopatía derivable al oftalmólogo. La sensibilidad fue del 66,7% con el retinógrafo no midriático sin dilatación, del 76,9% con dilatación electiva y del 85% con el retinógrafo midriático. Conclusiones. La concordancia, mediante biomicroscopia, ha sido «muy buena» y permite utilizar la exploración de un solo oftalmólogo como patrón de referencia. Es factible la transmisión telemática de la fotografía del fondo de ojo de pacientes diabéticos tipo 2 como método para detectar retinopatía. Las fotografías deberían realizarse dilatando, independientemente del tipo de retinógrafo empleado, ya que mejora significativamente la sensibilidad

Objective. Evaluate concordance in biomicroscopy evaluation of diabetic retinopathy degree among ophthalmologists. Validation of e-mail transmission of digital fundus photographs of type 2 diabetes patients as a method of diabetic retinopathy detection. Design. Descriptive study. Setting. Urban, primary health centre, and hospital. Participants. Type 2 diabetic patients selected of consecutive form when going to the primary health center (n=352). Main measurements. Parallel observer-blind evaluation of degree of retinopathy through biomicroscopy performed by ophthalmologists, against digital photographic images sent by e-mail taken by the family doctors. Concordance in the biomicroscopy among ophthalmologists was previously tested. Results. Retinopathy was revealed in 25.70% of the retinographs; 10.44% was mild, 12.05% moderate, and 3.21% severe. Weighted kappa was 0.876 for biomicroscopy concordance. Sensitivity in detecting retinopathy is 76.6% and specificity 95.2%; 92.7% and 99.5% for ophthalmologist-derivable retinopathy. Sensitivity was 66.7% for non-mydriatic retinograph without dilation, 76.9% with elective dilation, and 85% with the mydriatic. Conclusions. Concordance in evaluation of retinopathy degree through biomicroscopy was "very good." This allows using a single ophthalmologist's exploration as a reference model. E-mail transmission of the photograph of the back of the eye in type 2 diabetic patients as a retinopathy detection method is feasible. Regardless of the type of retinograph used, the photographs should be taken on the dilated eye, as this significantly improves sensitivity