Aims To evaluate the effectiveness of glaucoma screening using glaucoma suspect (GS) referral criteria assessed on colour fundus photographs in Singapore’s Integrated Diabetic Retinopathy Programme (SiDRP). Methods A case–control study. This study included diabetic subjects who were referred from SiDRP with and without GS between January 2017 and December 2018 and reviewed at Singapore National Eye Centre. The GS referral criteria were based on the presence of a vertical cup-to-disc ratio (VCDR) of ≥0.65 and other GS features. The final glaucoma diagnosis confirmed from electronic medical records was retrospectively matched with GS status. The sensitivity, specificity and positive predictive value (PPV) of the test were evaluated. Results Of 5023 patients (2625 with GS and 2398 without GS) reviewed for glaucoma, 451 (9.0%, 95% CI 8.2% to 9.8%) were confirmed as glaucoma. The average follow-up time was 21.5±10.2 months. Using our current GS referral criteria, the sensitivity, specificity and PPV were 81.6% (95% CI 77.7% to 85.1%), 50.6% (95% CI 49.2% to 52.1%) and 14.0% (95% CI 13.4% to 14.7%), respectively, resulting in 2257 false positive cases. Increasing the VCDR cut-off for referral to ≥0.80, the specificity increased to 93.9% (95% CI 93.1% to 94.5%) but the sensitivity decreased to 11.3% (95% CI 8.5% to 14.6%), with a PPV of 15.4% (95% CI 12.0% to 19.4%). Conclusions Opportunistic screening for glaucoma in a lower VCDR group could result in a high number of unnecessary referrals. If healthcare infrastructures are limited, targeting case findings on a larger VCDR group with high specificity will still be beneficial. Data are available on reasonable request.

中文翻译：

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在糖尿病视网膜病变远程眼科筛查项目中，使用基于彩色眼底照相的转诊标准评估青光眼筛查的结果


目的 使用新加坡综合糖尿病视网膜病变计划 (SiDRP) 中根据彩色眼底照片评估的青光眼疑似 (GS) 转诊标准来评估青光眼筛查的有效性。方法 病例对照研究。这项研究包括 2017 年 1 月至 2018 年 12 月期间从 SiDRP 转诊的患有或不患有 GS 的糖尿病受试者，并在新加坡国家眼科中心进行审查。 GS 转诊标准基于垂直杯盘比 (VCDR) ≥0.65 和其他 GS 特征。通过电子病历确认的最终青光眼诊断与 GS 状态进行回顾性匹配。评估了测试的敏感性、特异性和阳性预测值（PPV）。结果 在 5023 名接受青光眼检查的患者（2625 名患有 GS 和 2398 名不患有 GS）中，451 名（9.0%，95% CI 8.2% 至 9.8%）被确诊为青光眼。平均随访时间为21.5±10.2个月。使用我们当前的 GS 转诊标准，敏感性、特异性和 PPV 分别为 81.6%（95% CI 77.7% 至 85.1%）、50.6%（95% CI 49.2% 至 52.1%）和 14.0%（95% CI 13.4% 至 14.7） %），分别导致 2257 例假阳性病例。将转诊的 VCDR 截止值提高至 ≥0.80，特异性增加至 93.9%（95% CI 93.1% 至 94.5%），但敏感性下降至 11.3%（95% CI 8.5% 至 14.6%），PPV 为15.4%（95% CI 12.0% 至 19.4%）。结论 在 VCDR 较低的人群中进行青光眼机会性筛查可能会导致大量不必要的转诊。如果医疗保健基础设施有限，针对更大的 VCDR 群体的高特异性病例发现仍然是有益的。可根据合理要求提供数据。