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Qisi Sun, Laura Hall, Stephanie Heung, Peter Ryg, Lawrence Chan, Devika Sparks, Hilary Fazzone, Susan Forster; Evaluating the Diagnostic Ability of Vision Screenings Compared to Comprehensive Eye Exams in Detecting Early Pathology. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5064.
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© ARVO (1962-2015); The Authors (2016-present)
In order to reduce inequities in access to eye care, a cost-effective and convenient approach to eye care delivery that targets resources towards high-risk patients is required. This study tested the hypothesis that a vision screening is as effective as a comprehensive ophthalmologic exam in identifying common eye pathology such as refractive error (RE), glaucoma, diabetic retinopathy (DR) and age-related macular degeneration (AMD).
We enrolled 40 patients without known existing ocular pathology at a community clinic. We aimed to detect RE, glaucoma, DR, and AMD. The vision screening consisted of visual acuity testing, auto-refraction, intraocular pressure measurement by tonopen, Frequency Doubling Technology (FDT) visual field, fundus photos, optic disc photos, Optical Coherence Tomography (OCT) disc, OCT nerve fiber layer (NFL), and OCT macula. Participants then had a comprehensive exam by the Ophthalmologist. The Ophthalmologist had no access to screening data. Screening and comprehensive eye exam results were compared using statistical analyses.
The screening detected RE in 11 participants (27.5%) by auto-refraction; the comprehensive exam detected 26 patients (65%). The screening exam thus correctly identified 42.3% of these. Patients were considered glaucoma suspects in the screening if they had glaucomatous abnormality in at least one of the following: FDT, IOP, disc photos, or OCT NFL. Ophthalmologists identified 12 patients (30%) as glaucoma suspects/glaucoma-positive. The screening exam correctly detected 91.7% of these. Patients were considered DR suspects if they had a diabetic abnormality in at least one of the following: OCT of macula or fundus photos. Ophthalmologists identified 4 patients with DR (10%). The screening exam identified all 4 (100%). Patients were marked as having AMD if there was relevant abnormality in the OCT of macula or fundus photos. Ophthalmologists and the screening exam detected 1 patient with macular degeneration.
Our results appear to support the hypothesis that the vision screening is an effective tool at identifying common eye pathology. Although this was only in a subset of previously healthy patients at a community eye clinic, the screening was sensitive enough to detect 4 prevalent ocular pathologies with considerable accuracy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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