title: [Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors].
abstract: OBJECTIVE
  The aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG).
  
  
  METHODS
  An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist.
  
  
  METHODS
  Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic.
  
  
  METHODS
  A total of 196 patients of both genders, between 40-70years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses.
  
  
  METHODS
  For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC).
  
  
  RESULTS
  The retinography for OAG screening has a sensitivity of 21% (95%CI: 0-43%), a specificity of 93% (95%CI: 89-97%), a negative predictive value of 94% (95%CI: 90-97%), and positive of 20% (95%CI: 0-40%); positive probability ratio of 3.07 (95%CI: 0.98-9.62) and negative 0.84 (95%CI: 0.64-1.11). The IC was 0.653 (95%CI: 0.495-0.769) and kappa index of 0.140 (0.106ET).
  
  
  CONCLUSIONS
  According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved.
authors.affiliation: Medicina Familiar y Comunitaria, Consultorio de Santa Bárbara de Casa, Unidad de Gestión Clínica Andévalo Occidental, Santa Bárbara de Casa, Huelva, España. Electronic address: sorsangon@gmail.com.
authors.forename: Soraya
authors.initials: S
authors.lastname: Sánchez González
authors.affiliation: Medicina Familiar y Comunitaria, Unidad de Gestión Clínica El Molino de la Vega, Huelva, España.
authors.forename: José
authors.initials: J
authors.lastname: Calvo Lozano
authors.affiliation: Medicina Familiar y Comunitaria, Centro de Salud de Valverde del Camino, Área de Gestión Sanitaria Norte de Huelva, Valverde del Camino, Huelva, España.
authors.forename: Jessica
authors.initials: J
authors.lastname: Sánchez González
authors.affiliation: Medicina Familiar y Comunitaria, Unidad Docente de Medicina Familiar y Comunitaria de Huelva, Distrito Sanitario Huelva-Costa, Huelva, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pedregal González
authors.affiliation: Unidad de Gestión Clínica de Oftalmología, Hospital Infanta Elena, Complejo Hospitalario Universitario de Huelva, Huelva, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cornejo Castillo
authors.affiliation: Medicina Familiar y Comunitaria, Unidad Docente de Medicina Familiar y Comunitaria de Huelva, Distrito Sanitario Huelva-Costa, Huelva, España.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Molina Fernández
authors.affiliation: Unidad de Gestión Clínica de Oftalmología, Hospital Infanta Elena, Complejo Hospitalario Universitario de Huelva, Huelva, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Barral
authors.affiliation: Coordinación de Cuidados, Unidad de Gestión Clínica El Molino de la Vega, Huelva, España.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Pérez Espinosa
keywords: Atención primaria; Diagnosis; Diagnóstico; Glaucoma de ángulo abierto; Open angle glaucoma; Primary health care