Man versus machine: is technology a blessing or a barrier in screening for diabetic eye disease?
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BACKGROUND: The Standard Pseudoisochromatic Plates-Part 2 (SPP-2) are designed primarily as a screening test for acquired color vision deficiencies. However, results from several studies suggest that the SPP-2 may also be effective as a screening test for congenital red-green color vision defects. METHODS: In this study, the screening effectiveness of the SPP-2 was compared with the Standard Pseudoisochromatic Plates-Part 1 (SPP-1) to determine whether clinicians must use both tests: the SPP-1 to screen for congenital color vision defects and the SPP-2 to screen for acquired color vision defects. RESULTS: The results showed that, when using the recommended scoring criterion for the SPP-1, the SPP-2 test is slightly more sensitive in detecting congenital red-green defects. CONCLUSIONS: Clinicians can use the SPP-2 to screen for both congenital and acquired color vision defects.
We evaluated the cost-effectiveness of routine dilated fundus examination in improving visual outcomes. The cost of routine dilated fundus examination was related to the number of preventable cases of vision-threatening peripheral retinal disease. Patients with these diseases who had no risk factors were ascertained in a population of 1.75 million adults for a period of 6 months. Those whose last examination had been undilated were identified because only for them could routine dilated examination (RDE) have been substituted for undilated examination. The number of preventable cases was calculated for multiples of a 10% probability of prevention. The cost of RDE was determined from the number of undilated examinations in the same population and period and the cost of a single RDE. The number of patients who underwent undilated examination was estimated by random medical record review. The additional cost of a single RDE was determined from estimated examination times and payroll costs. Among patients without risk factors, 38 were identified for whom undilated examination rather than RDE had been performed. If prevention had been 10% effective, the substitution of 50,000 RDEs for undilated examinations costing the provider $433,000 would have been required per prevented case. These results suggest that most peripheral retinal diseases cannot be prevented by RDE. Routine dilated examination is an expensive test per prevented case. Published clinical guidelines lack evidence to recommend its use.
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To improve the cost-benefit ratio of our current screening program for retinopathy of prematurity (ROP), the records of 312 infants who had been screened for ROP were studied retrospectively. Using a safety-index containing three well known risk factors (birthweight, gestational age, oxygen use), infants were classified to be at high risk or low risk for the development of ROP. When all high risk infants would have been screened extensively from the 5th postnatal week onwards and all low risk infants would have been screened once at the 7th postnatal week, a 9.8% reduction of ophthalmological examinations would have been obtained at the expense of missing 2.9% of non vision threatening ROP.
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AIMS/BACKGROUND: The measurement of visual acuity is the most widely accepted indicator of amblyopia and is thought by some to be the only effective screening test. The aim of this study was to investigate the effectiveness of the traditional single optotype Sheridan-Gardiner test (SGT) in the measurement of visual acuity and the detection of amblyopia, compared with the log based linear format Glasgow acuity cards (GAC). METHODS: In the present study visual acuity was measured monocularly in 702 primary 1 schoolchildren using both acuity tests. RESULTS: A significant difference was found in the mean (SD) visual acuity measured with GAC (0.9 (0.08) modified logMAR) and SGT (1.13 (0.09) modified logMAR), df = 632, t = -59.08, p = 0.0001. The majority of children (89.3%) achieved visual acuities better than 6/6 in either eye when using the single optotype test. If the 95% confidence limits for a significant interocular difference in acuity are used as-criteria for the detection of unilateral amblyopia, GAC were found to be the most sensitive, correctly identifying 100%, while SGT identified 55% of the children with unilateral amblyopia. CONCLUSION: The results of this study highlight several problems with both the test format and testing procedure in the present school screening system.
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