¿Es útil la prueba de la linterna en atención primaria para detectar ojos con cámara anterior poco profunda? / Is the flashlight test of any use in primary care for detecting eyes with shallow anterior chamber?

Objetivo: Validar y analizar la utilidad de la prueba de la linterna (PdL) para detectar ojos con cámara anterior poco profunda en diabéticos en atención primaria. Diseño: Estudio descriptivo transversal. Emplazamiento: Centro de salud urbano y servicio de oftalmología de referencia, Logroño, España. Participantes: Setenta y cuatro personas, diabéticas de tipo 2 seleccionadas por muestreo consecutivo de entre las que acudían a la revisión anual. Se excluyeron aquéllas con dificultades para el desplazamiento, enfermedad y lesiones en los ojos que impedían la exploración. Se analizaron 145 ojos. Intervención: Un médico de familia y el residente realizaron la PdL. El oftalmólogo cumplimentó de modo ciego la prueba de Van Herick. Mediciones principales: Cálculo de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo (VPN), cociente de probabilidad positivo y cociente de probabilidad negativo (CPN). Para analizar la reproducibilidad se calculó el índice kappa ponderado. Resultados: El índice kappa fue del 75%. La especificidad fue de 88,9 y la sensibilidad fue de 90,9. El VPN fue del 98,9% (intervalo de confianza [IC] del 95%: del 96,1 al 100,0%). La probabilidad de que un paciente que presentaba un resultado negativo tuviera un ángulo con riesgo de desarrollar glaucoma fue del 1,1%. El CPN fue de 0,10 (IC del 95%: del 0,02 al 0,67%). Un paciente fue erróneamente etiquetado de no tener ángulo estrecho. Conclusiones: La PdL es válida y útil en diabéticos tipo 2 para descartar cámara anterior poco profunda. Es una prueba sencilla e inocua que puede ayudar al médico de familia a tomar una decisión sobre la midriasis farmacológica para observar el fondo de ojo (AU)

Objective: To validate and analyse the usefulness of the flashlight test (FT) in detecting eyes with a shallow anterior chamber in diabetic patients in primary care.Design Cross-sectional descriptive study. Setting: Urban health centre and a reference ophthalmology department, Logroño, Spain. Participants: A total of 74 patients with diabetes type 2, selected by consecutive sampling from those seen for an annual check-up. Those patients with movement difficulties, diseases and lesions of the eye, which would hamper the examination, were excluded. A total of 145 eyes were analysed. Intervention: A family doctor and the resident performed the FT. The ophthalmologist carried out the Van Herick test without knowing the results of the FT.Primary outcomes Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The reproducibility was calculated using weighted kappa index. Results: The kappa index was 75%. The specificity was 88.9% and the sensitivity was 98.9% (95% confidence interval (95% CI) 96.1–100.0%). The likelihood that a patient had a negative result could have an angle with a risk of developing glaucoma was 1.1%. The negative likelihood ratio (NLR) was 0.67%. One patient was incorrectly labelled as not having a narrow angle. Conclusions: The FT is valid and useful for ruling out shallow anterior chamber in type 2 diabetics. It is a simple and innocuous test that can help the family doctor make a decision on pharmacological mydriasis to observe the back of the eye (AU)

[Is the flashlight test of any use in primary care for detecting eyes with shallow anterior chamber?]. / Es útil la prueba de la linterna en atención primaria para detectar ojos con cámara anterior poco profunda?

OBJECTIVE: To validate and analyse the usefulness of the flashlight test (FT) in detecting eyes with a shallow anterior chamber in diabetic patients in primary care. DESIGN: Cross-sectional descriptive study. SETTING: Urban health centre and a reference ophthalmology department, Logroño, Spain. PARTICIPANTS: A total of 74 patients with diabetes type 2, selected by consecutive sampling from those seen for an annual check-up. Those patients with movement difficulties, diseases and lesions of the eye, which would hamper the examination, were excluded. A total of 145 eyes were analysed. INTERVENTION: A family doctor and the resident performed the FT. The ophthalmologist carried out the Van Herick test without knowing the results of the FT. PRIMARY OUTCOMES: Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The reproducibility was calculated using weighted kappa index. RESULTS: The kappa index was 75%. The specificity was 88.9% and the sensitivity was 98.9% (95% confidence interval (95% CI) 96.1-100.0%). The likelihood that a patient had a negative result could have an angle with a risk of developing glaucoma was 1.1%. The negative likelihood ratio (NLR) was 0.67%. One patient was incorrectly labelled as not having a narrow angle. CONCLUSIONS: The FT is valid and useful for ruling out shallow anterior chamber in type 2 diabetics. It is a simple and innocuous test that can help the family doctor make a decision on pharmacological mydriasis to observe the back of the eye.