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Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields.
Am J Ophthalmol. 2009 Jul; 148(1):111-8.AJ

Abstract

PURPOSE

To evaluate if simple- or multiple-field digital color nonmydriatic (NM) retinal images can replace 7 standard stereoscopic fundus photographs in the screening of diabetic retinopathy (DR).

DESIGN

Prospective, masked, comparative case series.

METHODS

One hundred and eight eyes of 55 diabetics were studied to determine single lesions and to grade clinical levels of DR and diabetic macular edema (DME) using both 1 and 3 NM digital color retinal images compared with the Early Treatment Diabetic Retinopathy Study (ETDRS) 7 standard 35-mm stereoscopic color fundus photographs (7F-ETDRS). All eyes underwent NM 45-degree field images of 1 central field (1F-NM), NM 45-degree field images of 3 fields (3F-NM), and, after pupil dilatation, 30-degree 7F-ETDRS photography. Images were analyzed by 2 independent, masked retinal specialists (S.V. and E.B.), lesion-by-lesion according to the ETDRS protocol and for clinical severity level of DR and DME according to the international classification of DR.

RESULTS

Using 7F-ETDRS as the gold standard, agreement was substantial for grading clinical levels of DR and DME (kappa = 0.69 and kappa = 0.75) vs 3F-NM; moderate for DR level (kappa = 0.56) and substantial for DME (kappa = 0.66) vs 1F-NM; almost perfect for detecting presence or absence of DR (kappa = 0.88) vs both 1F-NM and 3F-NM; and almost perfect for presence or absence of DME (kappa = 0.97) vs 3F-NM and substantial (kappa = 0.75) vs 1F-NM. Sensitivity and specificity for detecting referable levels of DR were 82% and 92%, respectively, for 3F-NM and 71% and 96%, respectively, for 1F-NM.

CONCLUSIONS

Three color 45-degree NM fundus fields may be an effective tool in a screening setting to determine critical levels of DR and DME for prompt specialist referral. One central 45-degree image is sufficient to determine absence or presence of DR and DME, but not for grading it.

Authors+Show Affiliations

Fondazione G.B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientificio), Roma, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19406376

Citation

Vujosevic, Stela, et al. "Screening for Diabetic Retinopathy: 1 and 3 Nonmydriatic 45-degree Digital Fundus Photographs Vs 7 Standard Early Treatment Diabetic Retinopathy Study Fields." American Journal of Ophthalmology, vol. 148, no. 1, 2009, pp. 111-8.
Vujosevic S, Benetti E, Massignan F, et al. Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields. Am J Ophthalmol. 2009;148(1):111-8.
Vujosevic, S., Benetti, E., Massignan, F., Pilotto, E., Varano, M., Cavarzeran, F., Avogaro, A., & Midena, E. (2009). Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields. American Journal of Ophthalmology, 148(1), 111-8. https://doi.org/10.1016/j.ajo.2009.02.031
Vujosevic S, et al. Screening for Diabetic Retinopathy: 1 and 3 Nonmydriatic 45-degree Digital Fundus Photographs Vs 7 Standard Early Treatment Diabetic Retinopathy Study Fields. Am J Ophthalmol. 2009;148(1):111-8. PubMed PMID: 19406376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields. AU - Vujosevic,Stela, AU - Benetti,Elisa, AU - Massignan,Francesca, AU - Pilotto,Elisabetta, AU - Varano,Monica, AU - Cavarzeran,Fabiano, AU - Avogaro,Angelo, AU - Midena,Edoardo, Y1 - 2009/05/05/ PY - 2008/10/17/received PY - 2009/02/10/revised PY - 2009/02/10/accepted PY - 2009/5/2/entrez PY - 2009/5/2/pubmed PY - 2009/7/2/medline SP - 111 EP - 8 JF - American journal of ophthalmology JO - Am J Ophthalmol VL - 148 IS - 1 N2 - PURPOSE: To evaluate if simple- or multiple-field digital color nonmydriatic (NM) retinal images can replace 7 standard stereoscopic fundus photographs in the screening of diabetic retinopathy (DR). DESIGN: Prospective, masked, comparative case series. METHODS: One hundred and eight eyes of 55 diabetics were studied to determine single lesions and to grade clinical levels of DR and diabetic macular edema (DME) using both 1 and 3 NM digital color retinal images compared with the Early Treatment Diabetic Retinopathy Study (ETDRS) 7 standard 35-mm stereoscopic color fundus photographs (7F-ETDRS). All eyes underwent NM 45-degree field images of 1 central field (1F-NM), NM 45-degree field images of 3 fields (3F-NM), and, after pupil dilatation, 30-degree 7F-ETDRS photography. Images were analyzed by 2 independent, masked retinal specialists (S.V. and E.B.), lesion-by-lesion according to the ETDRS protocol and for clinical severity level of DR and DME according to the international classification of DR. RESULTS: Using 7F-ETDRS as the gold standard, agreement was substantial for grading clinical levels of DR and DME (kappa = 0.69 and kappa = 0.75) vs 3F-NM; moderate for DR level (kappa = 0.56) and substantial for DME (kappa = 0.66) vs 1F-NM; almost perfect for detecting presence or absence of DR (kappa = 0.88) vs both 1F-NM and 3F-NM; and almost perfect for presence or absence of DME (kappa = 0.97) vs 3F-NM and substantial (kappa = 0.75) vs 1F-NM. Sensitivity and specificity for detecting referable levels of DR were 82% and 92%, respectively, for 3F-NM and 71% and 96%, respectively, for 1F-NM. CONCLUSIONS: Three color 45-degree NM fundus fields may be an effective tool in a screening setting to determine critical levels of DR and DME for prompt specialist referral. One central 45-degree image is sufficient to determine absence or presence of DR and DME, but not for grading it. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/19406376/Screening_for_diabetic_retinopathy:_1_and_3_nonmydriatic_45_degree_digital_fundus_photographs_vs_7_standard_early_treatment_diabetic_retinopathy_study_fields_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(09)00153-6 DB - PRIME DP - Unbound Medicine ER -