VALIDITY of FUNDOSCOPIC EXAMs for MASS SCREENING PROGRAMs
AtoZ Okamoto, Chizuru Hirooka (Osaka,JAPAN)
(paper presented at The 4th International Conference on Preventive@Cardiology [June 1997, at Montreal, CANADA])
[Purpose] To evaluate the validity of fundoscopic exams as part of community mass screening programs, the authors measured the sensitivity and specificity (Se, Sp) of fundoscopic findings made by two doctors and the agreement between them.
[Methods] The data used was fundoscopic pictures taken by Polaroid camera on local residents aged 40 or over who volunteered to take free mass screening programs sponsored by a local municipal government in 1991, 92.
All screening recipients were examined BP, UA, chest X ray, CBC and biochemistry but resting EKG and fundoscopic exams were optional and performed upon recipients' request. Two doctors reviewed fundoscopic pictures independently with no knowledge of recipients' health data according to the Scheie classification. However, for the purpose of analysis, dichotomous classification of (-) and (+) or over was employed for H and S findings.
[Results] Fundoscopic pictures of 209 recipients (66 males and 143 females, average age 57.56) were reviewed. Of those, 115 were hypertensive by WHO criteria. Se and Sp of H findings were 43.5%, 8.7% for Dr. X and 20.9%, 0.4% for Dr. Y. The percent agreement corrected for chance (Kappa value) was 0.22 for H findings and 0.13 for S findings.
[Conclusions] Since fundoscopic exams are subjective measurements, they are susceptible to individual variances even with well established criteria. Interpersonal agreement is "fair" for H findings and "poor" for S findings. The value of fundoscopic exams for mass screening is auxiliary at best and may better be limited to suspected severe cases of diabetes from the cost effectiveness viewpoint.
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