당뇨망막병증 검진에 있어 무산동 디지털 안저사진기의 효용성
Efficacy of Single-Field Non-Mydriatic Digital Fundus Photography for Screening Diabetic Retinopathy
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목적: 당뇨망막병증의 검진방법으로서 무산동 디지털 안저사진기의 효용성을 알아보고자 하였다. 대상과 방법: 당뇨병 환자 303명을 대상으로 산동 전후 45도 화각의 무산동 디지털 안저사진기를 이용하여 황반부 단일구역 안저촬영 을 시행하였고, 산동 후 도상검안경을 이용하여 안저검사를 시행하였다. 결과: 무산동 디지털 안저사진기의 당뇨망막병증 발견의 민감도와 특이도는 각각 47.6%, 97.6%였으며, 위양성률 2.3%, 위음성률 2.1%, 양성예측치 45.5% 음성예측치는 97.8%였다. 78안(12.9%)에서 안저사진의 질이 판독에 충분하지 않았으며, 안저사진의 질이 판독에 충분하지 않았던 군은 판독이 가능했던 군에 비해 많은 연령(p＜0.001), 긴 당뇨이환기간(p＜0.001), 높은 고혈압 이환율(p=0.003)을 나타냈다. 결론: 당뇨망막병증의 검진에 있어 무산동 디지털 안저사진기를 이용한 단일 구역 안저촬영은 특이도는 높았으나 낮은 민감도와 높은 기술적 실패를 나타내었다. 따라서 당뇨망막병증의 검진에 있어 무산동 디지털 안저사진기가 사용되기 위해서는 광범위 화각 촬영과 주변부 망막에 대한 추가 촬영이 필요할 것으로 생각된다.
Abstract
Purpose: To evaluate the efficacy of a single field, non-mydriatic, 45° digital photography as a diagnostic tool for diabetic retinopathy. Methods: A total of 303 consecutive diabetic patients (606 eyes) who underwent digital fundus photography and indirect ophthalmoscopy were included in the present study. The optical discs and macular area of all patients were subjected to single fundus photography using a non-mydriatic 45-degree digital fundus camera. All patients also underwent fundus examinations after pupil dilation via indirect ophthalmoscopy. Results: The sensitivity and specificity for determining diabetic retinopathy were 47.6% and 97.6%, respectively. The false positive rate, false negative rate, positive predictive value, and negative predictive values were 2.3%, 2.1%, 45.5%, and 97.8%, respectively. Among the digital fundus images, 12.9% (78 eyes) were non-gradable. The patients with non-gradable digital fundus images were older (p < 0.001), had a longer duration of diabetes, (p < 0.001) and more often suffered from systemic hypertension (p = 0.003) compared to patients with gradable photographs. Conclusions: The present study showed that single-field, non-mydriatic, 45 degree digital photography for detecting diabetic retinopathy had relatively low sensitivity and high technical failure rates. The failure rates could be improved with higher resolution non-mydriatic wide-field photography cameras and with additional peripheral images for diabetic retinopathy screening.
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