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Clinical question
Is routine funduscopy useful in identifying retinopathy in hypertensive
patients?
Bottom line
It is uncommon to see retinal changes by funduscopic examination in patients
with hypertension, although when retinal changes occur they are almost
always associated with hypertension. Though no studies have been performed
to check the reliability of an actual funduscopic examination, there was
only moderate agreement between 2 clinicians evaluating photographs of the
retina of hypertensive patients for early changes.
Reference
Van den Born BJ, Hulsman CA, Hoekstra JB, Schlingemann RO, Van Montfrans GA.
Value of routine funduscopy in patients with hypertension: systematic
review. BMJ 2005; 331:73-6.
Study design: Systematic review
Setting: Outpatient (any)
Synopsis
The researchers conducting this systematic review searched 3 databases to
find studies evaluating the assessment of the retina for microvascular
changes. The searches were done independently by 2 researchers and compared.
They included studies assessing the agreement between at least 2 clinicians
assessing photographs of the retina of hypertensive patients; in 5 studies
agreement between evaluators was fair or moderate for arteriolar narrowing
(kappa = 0.3 - 0.4) and arteriovenous nicking (kappa = 0.4 - 0.6) and
excellent for hemorrhages and exudates (kappa = .76 - .9). In 4 large
population-based studies, retinopathy occurred in relatively few patients
with hypertension, giving it a low sensitivity (3% - 21%). However, when it
occurred, it was almost always in patients with hypertension (88% - 98%),
giving it a high specificity.
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