Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation

ABSTRACT Objective To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. Methods A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. Results A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. Conclusion Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.

摘要 目的：评估基层医疗机构开具的视网膜检查的适应证、检查结果及实施策略。方法：本研究为回顾性研究，分析了临床散瞳眼底检查（clinical dilated fundus exams）与彩色眼底照相（color fundus photographs）两种检查方式的视网膜检查适应证与检查结果。对于视力正常且无眼部症状的以下患者，可纳入彩色眼底照相检查范畴：糖尿病（diabetes mellitus）及/或高血压（hypertension）患者、使用具有潜在视网膜毒性药物者、确诊或疑似青光眼患者、病情稳定且无症状的视网膜病变患者，但近视度数大于-3.00屈光度（diopter）者除外。结果：本研究共纳入1729例患者（女性占66%，年龄63.5±15.5岁），其中1190例接受了临床散瞳眼底检查，539例接受了彩色眼底照相。糖尿病患者占比32.2%。主要检查适应证为糖尿病（23.7%）与青光眼评估（23.5%）。3.4%的患者无明确检查适应证。主要检查异常结果为大杯盘比（cup/disc ratio，30.7%）与糖尿病视网膜病变（13.2%）。检查结果正常者占9.6%，检出周边视网膜病变者占7%，另有1%的患者无法完成检查。在符合彩色眼底照相纳入标准的患者（占比22.4%）中，超过半数接受了临床散瞳眼底检查。结论：就检查方式而言，适应证分布与诊断结果均无显著差异。彩色眼底照相可适配远程医疗（telemedicine）场景且成本效益更高，可在部分场景中作为首选检查策略。目前尚无针对视网膜检查适应证或首选检查方式的明确指南，本研究可为相关标准化工作提供参考，以优化公共卫生医疗资源配置。