Monoscopic versus Stereoscopic Retinal Photography for Grading Diabetic Retinopathy Severity

Abstract

PURPOSE.To assess agreement between monoscopic and stereoscopic photography for research classification of the severity of diabetic retinopathy (DR). METHODS. Monoscopic digital (MD) images were compared with stereo digital (SD) and film (SF) photographs from a 152-eye cohort with full-spectrum Early Treatment Diabetic Retinopathy Study (ETDRS) severity levels for agreement on severity level, DR presence with ascending severity threshold, presence of DR index lesions, and repeatability of grading. RESULTS. There was substantial agreement classifying ETDRS DR severity levels between MD and SF ( ϭ 0.65, w [linear weighted] ϭ 0.87), MD and SD ( ϭ 0.66, w ϭ 0.87), and SD and SF ( ϭ 0.62, w ϭ 0.86) images. Marginal homogeneity analyses found no significant difference between MD and SF images (P ϭ 0.53, Bhapkar test). The agreement between MD and SF ranged from 0.80 to 0.94 for the presence or absence of eight ascending DR severity thresholds. Repeatability between the readers of the MD images was equal to or better than that of the readers of SD or SF images. Severity threshold grading repeatability between readers was similar with the MD and SF images. The agreement between MD and SF for identifying diabetic retinopathy lesions ranged from moderate to almost perfect. The comparisons showed that performance of grading new vessels on the disc in MD images was slightly lower than that with the SF images. CONCLUSIONS. Monoscopic photography can equal the reliability of stereo photography for full ETDRS DR severity scale grading. (Invest Ophthalmol Vis Sci.

Mosaics Versus Early Treatment Diabetic Retinopathy Seven Standard Fields for Evaluation of Diabetic Retinopathy Severity

“…Monoscopic 7FD had already been compared with stereoscopic 7FD using the same cohort of eyes in a previous report (k = 0.66 [95% confidence interval, 0.57-0.74]; linear weighted k = 0.87 [95% confidence interval, 0.84-0.91]. 25 Kappa agreement of MosD with 7FF is slightly lower than 7FD versus 7FF, MosD versus 7FD, and monosopic 7FD versus 7FD. This is not surprising that given MosD differs from 7FF in all the three characteristics.…”

Telemedicine for detecting diabetic retinopathy: a systematic review and meta-analysis

“…Among the 20 included studies, four studies (all conducted by Li and colleagues) used the same subjects. 22–24 28 For this reason, only one of these studies was included in the meta-analysis, 23 giving a total of 17. In seven studies 15–19 23 29 the photographs were graded by ETDRS levels (levels 10, 14, 15, 20……).…”

Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy

“…147 Furthermore, the difference in detection between monoscopic and stereoscopic photography in practice may be less than expected. 148,149 For further information, see Appendix D.…”