Wide-field imaging and OCT vs clinical evaluation of patients referred from diabetic retinopathy screening

V Manjunath, V Papastavrou, D H W Steel, G Menon, R Taylor, T Peto, J Talks

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PURPOSE: Compare wide-field Optomap imaging and optical coherence tomography (OCT) with clinical examination in diabetic retinopathy (DR).

METHODS: Patients referred from Diabetic Eye Screening Programmes to three centres underwent dilated ophthalmoscopy and were assigned a DR grade. Wide-field colour imaging and OCT were then examined by the same clinician at that visit and a combined grade was assigned. Independent graders later reviewed the images and assigned an imaging-only grade. These three grades (clinical, combined, and imaging) were compared. The method that detected the highest grade of retinopathy, including neovascularisation, was determined.

RESULTS: Two thousand and forty eyes of 1023 patients were assessed. Wide-field imaging compared with clinical examination had a sensitivity and specificity of 73% and 96%, respectively, for detecting proliferative DR, 84% and 69% for sight-threatening DR, and 64% and 90% for diabetic macular oedema. Imaging alone found 35 more eyes with new vessels (19% of eyes with new vessels) and the combined grade found 14 more eyes than clinical examination alone.

CONCLUSIONS: Assessment of wide-field images and OCT alone detected more eyes with higher grades of DR compared with clinical examination alone or when combined with imaging in a clinical setting. The sensitivity was not higher as the techniques were not the same, with imaging alone being more sensitive. Wide-field imaging with OCT could be used to assess referrals from DR screening to determine management, to enhance the quality of assessment in clinics, and to follow-up patients whose DR is above the screening referral threshold but does not actually require treatment.

Original languageEnglish
Pages (from-to)416-23
Issue number3
Publication statusEarly online date - 16 Jan 2015
Externally publishedYes


  • Diabetic Retinopathy
  • Diagnostic Techniques, Ophthalmological
  • Humans
  • Physical Examination
  • Prospective Studies
  • Reproducibility of Results
  • Retinal Vessels
  • Sensitivity and Specificity
  • Tomography, Optical Coherence
  • Visual Acuity
  • Comparative Study
  • Journal Article
  • Multicenter Study
  • Research Support, Non-U.S. Gov't


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