The sensitivity and specificity of single-field nonmydriatic monochromatic digital fundus photography with remote image interpretation for diabetic retinopathy screening: a comparison with ophthalmoscopy and standardized mydriatic color photography11InternetAdvance publication at ajo.com. April 12, 2002.

Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes

“…Adherence to guidelines for an annual eye exam in patients with DM ranges from 34 to 65 percent [3][4], suggesting an urgent need for alternative strategies for assessing level of DR. Several technologies that offer simple, low-cost, and convenient digital photographic techniques for assessing level of DR have been evaluated and compared with the ETDRS seven standard field images. Over a wide range of populations, the sensitivity and specificity of these various digital exam methods substantially agreed with the ETDRS classification for the grading of DR [5,[8][9][10][11][12][13][14][15]. This substantial agreement between digital imaging and ETDRS standards appears to be consistent across a wide variety of systems, technologies, number of photographic fields obtained, image format (e.g., color vs monochromatic), and type of fundus camera used to obtain the images.…”

“…The perceived value of teleretinal imaging stems from the proven value of retinal photography per se in assessing level of DR. Several studies have shown that standard fundus photography through a dilated pupil is more sensitive than a direct ophthalmoscopic exam in screening for DR [14,[24][25][26][27][28]. However, standard fundus photography requires pupil dilation and is typically performed by trained personnel using specialized equipment to obtain ETDRS standard photographic fields [16], which reduce its cost-effectiveness as a screening tool.…”

“…Indeed, the operating characteristics of DR detection with teleretinal imaging compare with clinic-based ophthalmoscopy [5,[12][13][14][15]. A potentially important role for teleretinal imaging is to serve as a remote DR assessment and triage tool for the numerous patients with DM who are at lower risk yet require ongoing eye care.…”

Nonmydriatic Fundus Photography for Teleophthalmology Diabetic Retinopathy Screening in Rural and Urban Clinics

“…18 This is in contrast to some previous studies suggesting that a single central 45°fundus image may have good sensitivity and specificity to determine absence or presence of diabetic retinopathy but may not be as good for grading the severity. [21][22][23] By using the presence of macular hard exudates as a surrogate marker for possible diabetic macular edema, it has been estimated that 95% of eyes with suspected diabetic macular edema could be identified with nFP. 24 We initially hypothesized that diabetic retinopathy might be more common among diabetic patients screened in rural medical clinics than in an urban academic center because the rural sites would have limited access to eye care providers.…”

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

“…18,19 A number of DR screening strategies are available with different efficacies. 20 Systematic screening for DR with fundus photography has been implemented in the UK and Hong Kong, and it has been shown to be cost-effective for sight-threatening conditions from the provider's perspective (Fig 1). 21 However, the accuracy of the current DR screening protocol for DME remains unknown.…”