Application Of Non-mydriatic Fundus Photography In Aviators' Physical Examination

There are more than 80% outward information is received by visual pathway. How to maintain visual function is very important for flight pilots and also important for other aviators. There are ocular fundus changes in some system disease, besides ocular disease. Retinal vessels are sole microvascular structure that could be observed in vivo by a method. The retinal microvascular change is related to cardiovascular and cerebrovascular diseases and events and it suggested being predicting index. Direct ophthalmoscope is conventional method to observe ocular fundus. The results may be affected with the experiences of doctors and cannot be recorded in dynamic and objectively way. Digital ocular camera overcome the disadvantage of direct ophthalmoscope and provide an objectively method for medical evaluation, but it is not be used in aviation medicine in China now.In this study, the ocular fundus diseases in aviators were investigated by direct ophthalmoscope and non-mydriatic fundus photography and to explore the role of ocular fundus camera in clinical aviation medicine. Material and MethodsThe subjects were come from one Chinese Aviation Company and military flight pilots. The clinical examinations were conducted during annual physiological examination in 2006 and 2007. There were 1281 subject were examined for ocular fundus. There were 1207 and 987 subjects were examined by direct ophthalmoscope and non-mydriatic fundus photography, respectively. And there were 853 subjects were examined by both ways. The ocular fundus examine was independently taken by assigned specialist. The ocular fundus photography was taken one eye by another and saved into computer for further analysis. A trained doctor made the diagnosis of ocular fundus pictures. Other medical information was taken from aviator medical records. All statistics were used SPSS12.0 software analysis. The Chi-square was used to compare the detection rates of two methods, and the value of Kappa was to evaluate the consistency checking.Results1. The information of the ocular fundus diseases in aviatorsThe retina atherosclerosis was the first of the aircrew fundus diseases and was about 19.0%. The secondary abnormal were macular diseases and diabetic retinopathy and were about 5.3% and 2.8%, respectively. Some retinal hemorrhages, detachment and medullated nerve fibers of retina disease were also found.The number of flight engineers was less than the others and its prevalences of the ocular fundus diseases were 22.7%, 15.9% and 2.3%, respectively.The prevalences of the ocular fundus diseases were respectively 9.0%, 6.1% and 3.5% in air controllers. 1.61% of them were accepted the Lasik operation. The prevalences of the ocular fundus diseases were respectively 2.6%, 1.4% and 0.2% in air attendants. 9.52% of them were accepted the Lasik operation and 19.04% of them had the fudus change of high myopic eyes.2. The comparison between non-mydriatic fundus camera and the direct ophthalmoscopeIn our study, there were 853 subjects be examined by both methods. The prevalence of the ocular fundus diseases was 18.97%. The detection rate of direct ophthalmoscope was 20.75% and non-mydriatic fundus photography was 26.85%, there was statistically significant between them. Kappa value was 1.00(>0.75),the consistency of two mathods was well as size of test ofα=0.053. The information of"three-high"diseases in aviatorsThe prevalences of hyperlipemia, hypertension and hyperglycaemia were respectively 38.98%, 29.23% and 5.80% in pilots (in all years of age); they were respectively 30.00%, 5.81% and 5.55% in air controllers(≥40a); they were respectively 8.00%, 0.95% and 2.00% in air attendants(≥40a).4. Age, flight time and high blood pressure, high blood lipid incidence had certain relevance, occupational environmental and"three-high"disease also had a certain relationship.ConclusionAs a routine examination of aviation personnel, the ocular fundus examine was important for diagnosis of fundus including originated by systemic disease. The detection rate of non-mydriatic fundus photography was more than the direct ophthalmoscope. There was high prevalence of retina atherosclerosis, macular diseases and diabetic retinopathy in pilots and air controllers, which was similar to the prevalence of"three-high"disease. However, the prevalence of air attendants was low which the occupation may be an important influential factor. The ratio of Lasik operation and the number of fudus change of high myopic eyes in air attendants was higher than the others. It was hinted that the random blood sugar test can not reflect the true incidence of hyperglycosemia and diabetic because of the high prevalence of diabetic retinopathy in pilots and air controllers. Non- mydriasis fundus camera is a method of simple, objective record for the medical examination, its image data can be saved simply and communicated, it also can be applied to predict the crew of cardiovascular risk factors. Non- mydriasis fundus camera is worth well to apply for aeromedicine domain.