Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema
A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This...
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| Veröffentlicht in: | Hong Kong medical journal = Xianggang yi xue za zhi 2017-08, Vol.23 (4), p.356-364 |
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| container_title | Hong Kong medical journal = Xianggang yi xue za zhi |
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| creator | Wong, R Lm Tsang, C W Wong, D Sh McGhee, S Lam, C H Lian, J Lee, J Wy Lai, J Sm Chong, V Wong, I Yh |
| description | A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan.
This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy.
A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%.
The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optica |
| doi_str_mv | 10.12809/hkmj166078 |
| format | Article |
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This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy.
A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%.
The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.</description><identifier>ISSN: 1024-2708</identifier><identifier>EISSN: 2226-8707</identifier><identifier>DOI: 10.12809/hkmj166078</identifier><identifier>PMID: 28684650</identifier><language>eng</language><publisher>China: Hong Kong Academy of Medicine</publisher><subject>Aged ; Cost analysis ; Cross-Sectional Studies ; Diabetes ; Diabetic retinopathy ; Diabetic Retinopathy - diagnostic imaging ; Edema ; False Positive Reactions ; Female ; Fluorescein Angiography - statistics & numerical data ; Hong Kong ; Humans ; Macular Edema - diagnostic imaging ; Male ; Mass Screening - methods ; Mass Screening - statistics & numerical data ; Middle Aged ; Photography ; Retina ; Tomography, Optical Coherence - statistics & numerical data ; Workloads</subject><ispartof>Hong Kong medical journal = Xianggang yi xue za zhi, 2017-08, Vol.23 (4), p.356-364</ispartof><rights>2017. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c354t-35515a11211cc7892bfb87bcc9feb5c8871d32f67b8dc2d48ae06ef22396af863</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28684650$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, R Lm</creatorcontrib><creatorcontrib>Tsang, C W</creatorcontrib><creatorcontrib>Wong, D Sh</creatorcontrib><creatorcontrib>McGhee, S</creatorcontrib><creatorcontrib>Lam, C H</creatorcontrib><creatorcontrib>Lian, J</creatorcontrib><creatorcontrib>Lee, J Wy</creatorcontrib><creatorcontrib>Lai, J Sm</creatorcontrib><creatorcontrib>Chong, V</creatorcontrib><creatorcontrib>Wong, I Yh</creatorcontrib><creatorcontrib>Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong</creatorcontrib><title>Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema</title><title>Hong Kong medical journal = Xianggang yi xue za zhi</title><addtitle>Hong Kong Med J</addtitle><description>A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan.
This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy.
A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%.
The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.</description><subject>Aged</subject><subject>Cost analysis</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes</subject><subject>Diabetic retinopathy</subject><subject>Diabetic Retinopathy - diagnostic imaging</subject><subject>Edema</subject><subject>False Positive Reactions</subject><subject>Female</subject><subject>Fluorescein Angiography - statistics & numerical data</subject><subject>Hong Kong</subject><subject>Humans</subject><subject>Macular Edema - diagnostic imaging</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Mass Screening - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Photography</subject><subject>Retina</subject><subject>Tomography, Optical Coherence - statistics & numerical data</subject><subject>Workloads</subject><issn>1024-2708</issn><issn>2226-8707</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkV1L5TAQhsOirMePK-8l4M2C1E2mbZJeicj6AYI37nVJ0sk5PbZNTRrFP-Dv3nr8gr0aZnjmYZiXkEPOTjkoVv1ePfRrLgST6gdZAIDIlGRyiyw4gyIDydQO2Y1xzRiosmI_yQ4ooQpRsgV5PQ9In5H2-qEdlnTpfUNTROod9SnQMZmutTRgnDuL8Yzer5A63UXMRh_bqX1CGvS0WYg2IA5vGvNCXRqaFOm48pNfBj2u5pEPtGm1wWlW9tqmTgfqscFe75PtjfTgo-6Rv5d_7i-us9u7q5uL89vM5mUxZXlZ8lJzDpxbK1UFxhkljbWVQ1NapSRvcnBCGtVYaAqlkQl0AHkltFMi3yO_3r1j8I8J41T3bbTYdXpAn2LNKy5zUQhWzejxf-h6_sEwX1eDVAIElBvhyTtlg48xoKvH0PY6vNSc1Zt46u94Zvrow5lMj80X-5lH_g_MhYyL</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Wong, R Lm</creator><creator>Tsang, C W</creator><creator>Wong, D Sh</creator><creator>McGhee, S</creator><creator>Lam, C H</creator><creator>Lian, J</creator><creator>Lee, J Wy</creator><creator>Lai, J Sm</creator><creator>Chong, V</creator><creator>Wong, I Yh</creator><general>Hong Kong Academy of Medicine</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BVBZV</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema</title><author>Wong, R Lm ; Tsang, C W ; Wong, D Sh ; McGhee, S ; Lam, C H ; Lian, J ; Lee, J Wy ; Lai, J Sm ; Chong, V ; Wong, I Yh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c354t-35515a11211cc7892bfb87bcc9feb5c8871d32f67b8dc2d48ae06ef22396af863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Cost analysis</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes</topic><topic>Diabetic retinopathy</topic><topic>Diabetic Retinopathy - diagnostic imaging</topic><topic>Edema</topic><topic>False Positive Reactions</topic><topic>Female</topic><topic>Fluorescein Angiography - statistics & numerical data</topic><topic>Hong Kong</topic><topic>Humans</topic><topic>Macular Edema - diagnostic imaging</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Mass Screening - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Photography</topic><topic>Retina</topic><topic>Tomography, Optical Coherence - statistics & numerical data</topic><topic>Workloads</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, R Lm</creatorcontrib><creatorcontrib>Tsang, C W</creatorcontrib><creatorcontrib>Wong, D Sh</creatorcontrib><creatorcontrib>McGhee, S</creatorcontrib><creatorcontrib>Lam, C H</creatorcontrib><creatorcontrib>Lian, J</creatorcontrib><creatorcontrib>Lee, J Wy</creatorcontrib><creatorcontrib>Lai, J Sm</creatorcontrib><creatorcontrib>Chong, V</creatorcontrib><creatorcontrib>Wong, I Yh</creatorcontrib><creatorcontrib>Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>East & South Asia Database</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Hong Kong medical journal = Xianggang yi xue za zhi</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, R Lm</au><au>Tsang, C W</au><au>Wong, D Sh</au><au>McGhee, S</au><au>Lam, C H</au><au>Lian, J</au><au>Lee, J Wy</au><au>Lai, J Sm</au><au>Chong, V</au><au>Wong, I Yh</au><aucorp>Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema</atitle><jtitle>Hong Kong medical journal = Xianggang yi xue za zhi</jtitle><addtitle>Hong Kong Med J</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>23</volume><issue>4</issue><spage>356</spage><epage>364</epage><pages>356-364</pages><issn>1024-2708</issn><eissn>2226-8707</eissn><abstract>A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan.
This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy.
A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%.
The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.</abstract><cop>China</cop><pub>Hong Kong Academy of Medicine</pub><pmid>28684650</pmid><doi>10.12809/hkmj166078</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cost analysis Cross-Sectional Studies Diabetes Diabetic retinopathy Diabetic Retinopathy - diagnostic imaging Edema False Positive Reactions Female Fluorescein Angiography - statistics & numerical data Hong Kong Humans Macular Edema - diagnostic imaging Male Mass Screening - methods Mass Screening - statistics & numerical data Middle Aged Photography Retina Tomography, Optical Coherence - statistics & numerical data Workloads |
| title | Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema |
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