gms | German Medical Science

To screen retinal vessels in respect to microvascular abnormalities in a multicentric telemedical setting.

By trained technicians the retinal vessels from both eyes were registered by a non-mydriatic fundus camera (45°, Kowa). A standardised medical history was performed and completed. The images and the data were electronically sent by MedStage (Siemens AG) to a web-server. By trained technicians the arterio-venous ratio was calculated using the Parr-Hubbard-formula. Ophthalmologists evaluated the retinal fundus image using a standardised web-based document. The result of the evaluation became available for the examined subject by a web-based report. From 1.9.2001 to 1.10.2003 in the ongoing prospective study 27.234 subjects were examined and evaluated. The mean age was 48±8 years. The subjects reported in 27% arterial hypertension, in 26% hyperlipidemia, in 4% coronary heart disease, and in 2.5% diabetes. The arterial and diastolic blood pressure was in average 129±14mmHg,and 82±9mmHg, respectively.

The intraobserver- and interobserver- reproducibility (alpha-Kronbach-coefficient) of the measurement of the arterio-venous ratio was 0,97, and 0,798, respectively. The quality of images was good. In respect to the measurement of the arterio-venous ratio 4.3% of the images were unable to process, 15,3%, and 80.5% of the images showed moderate, and good quality, respectively measuring the arterio-venous ratio. In respect to the ophthalmological evaluation in 1,1% of the images an evaluation was not possible due to bad quality, 10,2%, and 88,7% of the images showed moderate, and good quality, respectively.

A multicenter approach of screening of the retina with a central evaluation by ophthalmologists in a reading center allows screenings of more than 100 persons per day with good quality and good reproducibility.