SDOCT Imaging to Identify Macular Pathology in Patients Diagnosed with Diabetic Maculopathy by a Digital Photographic Retinal Screening Programme

Abstract

IntroductionDiabetic macular edema (DME) is an important cause of vision loss. England has a national systematic photographic retinal screening programme to identify patients with diabetic eye disease. Grading retinal photographs according to this national protocol identifies surrogate markers for DME. We audited a care pathway using a spectral-domain optical coherence tomography (SDOCT) clinic to identify macular pathology in this subset of patients.MethodsA prospective audit was performed of patients referred from screening with mild to moderate non-proliferative diabetic retinopathy (R1) and surrogate markers for diabetic macular edema (M1) attending an SDOCT clinic. The SDOCT images were graded by an ophthalmologist as SDOCT positive, borderline or negative. SDOCT positive patients were referred to the medical retina clinic. SDOCT negative and borderline patients were further reviewed in the SDOCT clinic in 6 months.ResultsFrom a registered screening population of 17 551 patients with diabetes mellitus, 311 patients met the inclusion criteria between (March 2008 and September 2009). We analyzed images from 311 patients’ SDOCT clinic episodes. There were 131 SDOCT negative and 12 borderline patients booked for revisit in the OCT clinic. Twenty-four were referred back to photographic screening for a variety of reasons. A total of 144 were referred to ophthalmology with OCT evidence of definite macular pathology requiring review by an ophthalmologist.DiscussionThis analysis shows that patients with diabetes, mild to moderate non-proliferative diabetic retinopathy (R1) and evidence of diabetic maculopathy on non-stereoscopic retinal photographs (M1) have a 42.1% chance of having no macular edema on SDOCT imaging as defined by standard OCT definitions of DME when graded by a retinal specialist. SDOCT imaging is a useful adjunct to colour fundus photography in screening for referable diabetic maculopathy in our screening population.

An observational study to assess if automated diabetic retinopathy image assessment software can replace one or more steps of manual imaging grading and to determine their cost-effectiveness

“…This study protocol was registered with the HTA study number 11/21/02 and protocol published online on 23 2 Diabetic retinopathy is a common complication of diabetes mellitus and is one of the major causes of vision loss in the working-age population. 3 However, in the UK, diabetic retinopathy is no longer the leading cause of vision loss in this age group.…”

“…Recent work has also shown that optical coherence tomography (OCT) imaging is a useful adjunct to colour fundus photography in screening for referable diabetic maculopathy and has the potential to significantly reduce over-referral of cases of macula oedema compared with human assessment of colour fundus images. 23 Some hospital eye services are already incorporating OCT assessment within their DESP. 24 …”

Repeatability and Reproducibility of Choroidal Vessel Layer Measurements in Diabetic Retinopathy Using Enhanced Depth Optical Coherence Tomography

“…15 Patient age at time of attendance, and presence of ocular comorbidity, were obtained from electronic patient records.…”

Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema

“…These criteria are as follows: the presence of intraretinal cysts, subretinal fluid and/or diffuse retinal oedema (retinal thickening with areas of reduced retinal reflectivity on OCT scans) on more than one scan, or any of the above associated with a change in the ILM contour (Fig 2), including increased CMT or loss of foveal contour. 27 A qualitative and quantitative assessment of the macula with OCT can objectively diagnose or exclude macular oedema. It is worth noting that some believe macular thickness should not be included as an OCT criterion for determining the presence of DME.…”