[The application study of community-based tele-screening system for diabetic retinopathy in Beixinjing Blocks, Shanghai].
OBJECTIVE
To design the community-based tele-screening system for diabetic retinopathy and evaluate the feasibility of it.


METHODS
Cross-sectional study. The tele-screening system was based on non-mydriatic digital eye fundus camara photography and computer network technology. 109 type 2 diabetes mellitus residents were randomly selected for system evaluation, which included: (1) The consistency of the far visual acuity examined by an ophthalmologist and a trained inspector, evaluated by paired t-sample test; the consistency of diagnosis of diabetic retinopathy by tele-screening system and traditional screening method by ophthalmoscope, slit-lamp bimicroscope combined with non-contact lens after pupil dilation, evaluated by kappa value and intraclass coefficient correlation. (2) The proper compression ratio of the fundus photographs transferring through the internet, evaluated by intraclass coefficient correlation. (3) The working time for the tele-screening on the residents, comparing with the traditional screening method.


RESULTS
The visual acuities of the 218 eyes in 109 residents examined by an ophthalmologist were < 0.05 in 13 eyes, between 0.05 and 0.3 in 61 eyes, > or = 0.3 in 144 eyes. No significant difference was found between the vision acuity given by different examiner (t = -0.572, P = 0.568). 52 eyes were diagnosed as DR by traditional screening method, while 51 eyes were diagnosed as DR by the tele-screening method, so in DR diagnosis, high consistency were found with kappa value as 0.885, 95%CI 0.807 to 0.963, and in DR degree diagnosis with ICC value as 0.91, 95%CI 0.85 to 0.94. The most compression ratio of fundus photographs was as low as 15% (526 x 350). It took 5 to 7 minutes for the tele-screening system to examining and giving diagnosis of a diabetes mellitus resident, a little bit sooner than traditional screening method.


CONCLUSIONS
This community-based tele-screening system can meet the requirements of mass screening for diabetic retinopathy.
Peng
Jin-juan
JJ
Department of Ophthalmology, Shanghai First People's Hospital, Affiliated Shanghai Jiaotong University, Shanghai 200080, China.
Zou
Hai-dong
HD
Wang
Wei-wei
WW
Fu
Jiong
J
Shen
Bin-jie
BJ
Xu
Xun
X
Zhang
Xi
X
Zhao
Nai-qing
NQ
Yu
Yong-fu
YF
D002681:China; D003153:Community Health Services / Q000379:methods; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D019114:Remote Consultation / Q000379:methods*