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S.L. Mansberger, G.A. Cioffi, D. Choi, C.A. Johnson; Screening Tests for Visually Significant Eye Diseases in American Indian/Alaska Native Participants . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3472.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the association of screening test results for visually significant eye diseases in American Indian/Alaskan Natives (AI/AN) in the Pacific Northwest.
We randomly enrolled AI/AN over the age of 40 years from three tribes. Ophthalmic technicians performed a baseline exam on all participants including refraction, frequency doubling technology perimetry (FDT), limbal anterior chamber depth, confocal scanning laser ophthalmoscopy (CSLO), nonmydriatic digital imaging, pachymetry, and Tonopen® tonometry. An ophthalmologist performed a dilated full eye exam in participants: 1) with a history of visually significant eye diseases or diabetes; 2) who were screening failures; and 3) 30% of those with normal results. We defined a screening failure (either eye) as: best–corrected distance visual acuity (VA) worse than 20/30; abnormal, unreliable, or indeterminate FDT result; limbal chamber depth less than 25% of corneal thickness in the temporal quadrant; CSLO testing with borderline or abnormal Moorfields regression result; poor quality CSLO image; intraocular pressure (IOP) greater than 21 mm Hg; retinal disease seen with nonmydriatic imaging; or poor quality nonmydriatic imaging. A participant was a screening failure if they had at least one abnormal test in either eye. We used binary logistic univariate and stepwise multivariate statistical analyses to test the association between screening test results and ophthalmoligist confirmed results.
Out of 298 participants, 199 (66%) had one or more abnormal screening test results in one or both eyes. All patients with normal screening results had a normal ophthalmology exam. The proportion of participants with abnormal screening tests were: VA–10.1%, FDT perimetry–54.2%, limbal depth–16.1%, CSLO imaging borderline or abnormal–32.1%, poor quality CSLO imaging–9.6%, IOP–3.2%, retinal disease with nonmydriatic imaging–8.8%, and poor quality nonmydriatic imaging–10.5%. Abnormal nonmydriatic imaging, FDT abnormality, poor quality CSLO image, and VA worse than 20/30 were associated with eye disease (p=.19); abnormal CSLO and FDT were associated with glaucoma (p=.07); abnormal nonmydriatic imaging was associated with retinal disease (p=0.05); VA worse than 20/30 was associated with cataract (p=.13); and poor quality CSLO image was associated with ARMD (p=.04).
The negative predictive value of the screening test results was high. Visual acuity, CSLO, nonmydriatic camera, and FDT testing were most likely to be associated with visually significant eye diseases.
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