Comparison of 1-Field and 2-Field Mydriatic Handheld Retinal Imaging with Early Treatment Diabetic Retinopathy Study (ETDRS) 7-Standard Field Photography for Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME)

Abdulrahman Rageh, Cris Martin Jacoba, Recivall Pascual Salongcay, Lizzie Anne Aquino, Claude Michael Salva, Aileen Viguilla Saunar, Glenn Alog, Tunde Peto, Mohamed Ashraf Elmasry, Jennifer K Sun, Lloyd Paul Aiello, Paolo S Silva

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Abstract

Purpose : To determine agreement of 1-field (1F, macula centered) and 2-field (2F, disc/macula) mydriatic handheld retinal imaging with standard ETDRS photography for DR/DME.

Methods : Images from 177 eyes of 92 patients with diabetes were evaluated. By ETDRS photos: no DR 40.1% eyes, mild NPDR 19.2%, moderate 14.7%, severe 10.2%, proliferative DR 15.8%; no DME 72.9%, DME 6.8%, CSME 17.0%, ungradable 3.4%. Ungradable rate for DR and a summary of results are shown in Table 1. DME was ungradable in AU:10.2%, SS:13.0%, RV:5.7%. 2F imaging increased exact agreement of DR grading between handheld retinal imaging and ETDRS photos by 8.3% AU, 15.2% SS, 6.3% RV; agreement within 1-step was increased by 6.1% AU, 10.1% SS, 1.3% RV. 2F imaging with AU/SS increased K and KW although it remained moderate. 2F imaging did not substantially increase sensitivity for any DR, refDR and vtDR across all devices.

Results : Images from 177 eyes of 92 patients with diabetes were evaluated. By ETDRS photos: no DR 40.1% eyes, mild NPDR 19.2%, moderate 14.7%, severe 10.2%, proliferative DR 15.8%; no DME 72.9%, DME 6.8%, CSME 17.0%, ungradable 3.4%. Ungradable rate for DR and a summary of the results is shown in table 1. DME was ungradable in AU:10.2%, SS:13.0%, RV:5.7%. 2F imaging increased exact agreement of DR grading between handheld retinal imaging and ETDRS photos by 8.3% AU, 15.2% SS, 6.3% RV; agreement within 1-step was increased by 6.1% AU, 10.1% SS, 1.3% RV. 2F imaging increased kappa agreement with ETDRS photos for DR by 11.3% AU and 15.6% SS. 2F imaging did not significantly increase sensitivity for any DR, refDR and vtDR across all devices.

Conclusions : Handheld 1F imaging with a field of view less than 600 do not meet established standards for sensitivity (80%) and specificity (90%) in identifying DR and refDR. Ungradable rate was reduced by 36-50% and agreement with ETDRS was increased (6.3-15.2%) with the acquisition of a second field. The benefit of a second field decreased as the field of view of the device increased. For the tested instruments, a minimum handheld 1F 600 or 2F imaging are needed to adequately determine referable DR in DR screening programs
Original languageEnglish
JournalInvestigative Opthalmology and Visual Science
Volume62
Issue number8
Publication statusPublished - 01 Jun 2021
EventAssociation for Research in Vision and Ophthalmology (ARVO) 2021 -
Duration: 01 May 202107 May 2021

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