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

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• 作者：Paolo S. Silva ; Jerry D. Cavallerano ; Jennifer K. Sun ; Jason Noble ; Lloyd M. Aiello ; Lloyd Paul Aiello
• 刊名：American Journal of Ophthalmology
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：154
• 期：3
• 页码：549-559.e2
• 全文大小：1686 K

文摘

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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 % (K_W = 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 % (K_W = 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.