Nonmydriatic Ultrawide Field Retinal Imaging Compared With Dilated Standard 7-Field 35-mm Photography and Retinal Specialist Examination for Evaluation of Diabetic Retinopathy

• Published in: American journal of ophthalmology 2012-09, Vol.154 (3), p.549-559.e2
• Main Authors: Silva, Paolo S, Cavallerano, Jerry D, Sun, Jennifer K, Noble, Jason, Aiello, Lloyd M, Aiello, Lloyd Paul
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Agreements; Biological and medical sciences; Confidence intervals; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - classification; Diabetic Retinopathy - diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Health Insurance Portability & Accountability Act 1996-US; Hospitals; Humans; Lasers; Macular Edema - diagnosis; Male; Medical sciences; Middle Aged; Miscellaneous; Mydriatics - administration & dosage; Ophthalmology; Photography; Photography - instrumentation; Photography - methods; Prospective Studies; Pupil - drug effects; Reproducibility of Results; Retina - pathology; Retinopathies; Sensitivity and Specificity; Severity of Illness Index; Signal Processing, Computer-Assisted; Specialization; Telemedicine; Womens health; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2012.03.019

Purpose To compare nonmydriatic stereoscopic Optomap ultrawide field images with dilated stereoscopic Early Treatment Diabetic Retinopathy Study 7-standard field 35-mm color 30-degree fundus photographs (ETDRS photography) and clinical examination for determining diabetic retinopathy (DR) and diabetic macular edema (DME) severity. Design Single-site, prospective, comparative, instrument validation study. Methods One hundred three diabetic patients (206 eyes) representing the full spectrum of DR severity underwent nonmydriatic ultrawide field 100-degree and 200-degree imaging, dilated ETDRS photography, and dilated fundus examination by a retina specialist. Two independent readers graded images to determine DR and DME severity. A third masked retina specialist adjudicated discrepancies. Results Based on ETDRS photography (n = 200), the results were as follows: no DR (n = 25 eyes [12.5%]), mild nonproliferative DR (NPDR; 47 [23.5%]), moderate NPDR (61 [30.5%]), severe NPDR (11 [5.5%]), very severe NPDR (3 [1.5%]), and proliferative DR (52 [2.5%]). One (0.5%) eye was ungradable and 6 eyes did not complete ETDRS photography. No DME was found in 114 eyes (57.0%), DME was found in 28 eyes (14.0%), and clinically significant DME was found in 47 eyes (23.5%), and 11 (5.5%) eyes were ungradable. Exact DR severity agreement between ultrawide field 100-degree imaging and ETDRS photography occurred in 84%, with agreement within 1 level in 91% (KW = 0.85; K = 0.79). Nonmydriatic ultrawide field images exactly matched clinical examination results for DR in 70% and were within 1 level in 93% (KW = 0.71; K = 0.61). Nonmydriatic ultrawide field imaging acquisition time was less than half that of dilated ETDRS photography ( P < .0001). Conclusions Nonmydriatic ultrawide field images compare favorably with dilated ETDRS photography and dilated fundus examination in determining DR and DME severity; however, they are acquired more rapidly. If confirmed in broader diabetic populations, nonmydriatic ultrawide field imaging may prove to be beneficial in DR evaluation in research and clinical settings.