Scanning laser ophthalmoscopy in the retromode in diabetic macular oedema

Abstract

Abstract.Purpose: To determine the validity of scanning laser ophthalmoscopy in the retromode (RM‐SLO) versus other imaging modalities in the diagnosis of diabetic macular oedema (DME).Methods: Two hundred and sixty‐three eyes were examined. Inclusion criteria were any stage of untreated or treated diabetic retinopathy and four imaging modalities of the macula carried out on the same day: time domain optical coherence tomography (OCT), fundus autofluorescence (FAF), RM‐SLO and fluorescein angiography (FA). Two masked retinal specialists independently graded all images. Agreement between RM‐SLO and OCT, FA and FAF in evaluating the presence and patterns of DME was evaluated by kappa statistics, sensitivity, specificity, observed proportional agreement, and proportional agreement in positive and negative cases.Results: The agreement in evaluating the presence/absence of DME between RM‐SLO and OCT, FA and FAF was good: κ = 0.73 (confidence interval; CI, 0.64–0.83), κ = 0.71 (CI, 0.61–0.81) and κ = 0.73 (CI, 0.63–0.83), respectively. The agreement in evaluating cystoid pattern of DME was almost perfect between RM‐SLO and OCT, RM‐SLO and FA, κ > 0.8; and good between RM‐SLO and FAF, κ > 0.7. The agreement in evaluating the presence/absence of subfoveal neuroretinal was almost perfect between RM‐SLO and OCT (κ = 0.83; 95% CI, 0.70–0.96). Subfoveal neuroretinal detachment did not show any specific pattern on FA or FAF. Sensitivity and specificity of RM‐SLO in evaluating DME was 97.7% and 71.9% versus OCT, 97.4% and 68.1% versus FA and 96.1% and 73.3% versus FAF. Retinal thickness of 233 μm represented the cut‐off value to define DME by RM‐SLO.Conclusions: The combined use of non‐invasive imaging techniques can improve the diagnostic interpretation of different aspects of DME.

Accuracy of fundus autofluorescence imaging for the diagnosis and monitoring of retinal conditions: a systematic review

“…Four of the studies involved the analysis of retrospective data, 84,97,100,101 two involved prospective recruitment of patients, 96,99 one appeared to prospectively recruit patients, although this was not explicitly reported, 83 and it is unclear whether the remaining study was retrospective or prospective 98 (see Table 2). Four of the studies selected patients consecutively (i.e.…”

“…Four of the studies selected patients consecutively (i.e. in the chronological order in which they first presented to clinicians) 84,97,98,100 and the remaining studies did not report whether selection was consecutive. 83,96,99,101 Retrospective studies, and those lacking consecutive patient recruitment, may be at greater risk of selection bias, and this is considered further below in relation to the overall assessment of the quality of evidence (see Quality of research available).…”

“…Although FAF imaging may be used to detect autofluorescence in a wide range of retinal diseases (see Chapter 1), the eight included studies 83,84,[96][97][98][99][100][101] cover only three broad retinal conditions. These are AMD (four studies 96,97,99,101 ) cystoid macular oedema (two studies 83,100 ) and diabetic macular oedema (two studies 84,98 ). Of four studies on AMD, three studies specifically investigated FAF imaging in the detection of reticular pseudodrusen 96,97,101 and one study investigated FAF imaging in the diagnosis of choroidal neovascularisation.…”

“…Hogg and colleagues 96 conducted studies in Italy, Portugal and the UK, and Smith and colleagues 101 in the USA and UK. The remaining studies were conducted in Italy, 98 Portugal, 99 Turkey 83 and Japan. 97 The studies were published between 2006 and 2014.…”

“…83,84,[96][97][98][99][100][101] Full details of these studies, including our assessment of their methodological rigour, are given in the data extraction forms (see Appendix 5).…”