The Sensitivity and Specificity of Nonmydriatic Digital Stereoscopic Retinal Imaging in Detecting Diabetic Retinopathy

Abstract

OBJECTIVE -The objective of this study was to determine the sensitivity and specificity of Joslin Vision Network nonmydriatic digital stereoscopic retinal imaging (NMDSRI) as a screening tool in detecting diabetic retinopathy.RESEARCH DESIGN AND METHODS -We reviewed the records of 244 patients with diabetes who had a dilated funduscopic examination (DFE) and NMDSRI done within 1 year of each other at four locations in the metropolitan Washington, DC, area. The images were transmitted through a local area network to a central reading location where they were graded by a single retinal specialist.RESULTS -Images of 482 eyes from 243 patients were included in the study. Four images did not transmit, and 35% of the images were not gradable. Of the remaining 311 eyes, there was 86% agreement in the grading between NMDSRI and DFE: 227 eyes with no diabetic retinopathy and 40 eyes with diabetic retinopathy. In 46 eyes (15%) there was a disagreement between gradings made by the two techniques. NMDSRI detected diabetic retinopathy in 35 eyes reported as normal by DFE, and in the remaining 11 eyes, the DFE grade was one grade higher than the NMDSRI grade. Adjudicated nonconcordant examinations were within one grade. In the 76 eyes with diabetic retinopathy, retinal thickness could not be assessed in 17 (21%) eyes. When the NMDSRI result was gradable, the overall sensitivity of NMDSRI was 98% and the specificity was 100% for retinopathy within one grade of the DFE. In the limited number of eyes that had diabetic retinopathy with macular edema (six), agreement with the clinical examination was 100%.CONCLUSIONS -NMDSRI is a sensitive and specific method for the screening and diagnosis of diabetic retinopathy, which may help improve compliance with the standards of eye care for patients with diabetes. Diabetes Care 29:2205-2209, 2006D iabetes is the leading cause of new cases of blindness among adults aged 20 -74 years with diabetic retinopathy, causing as many as 24,000 new cases of blindness per year (1). Crude prevalence rates of diabetic retinopathy and vision-threatening retinopathy in adults Ն40 years of age are 40.3 and 8.2%, respectively (2). In those with type 1 diabetes, the crude prevalences of any diabetic retinopathy were 74.9 versus 82.3% in black and white individuals, respectively, and of vision-threatening retinopathy were 30.0 versus 32.2%, respectively (3). Because the prevalence of diabetes is projected to increase by 35% worldwide between the years 1995 and 2025 (4), the number of Americans with blindness and significant visual impairment will probably rise as well. The high incidence of visual loss and the fact that even severe diabetic retinopathy may be asymptomatic provide strong support for screening (5). The Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS) showed that early treatment can reduce an individual's risk of severe vision loss by 57% (6,7). Moreover, focal laser photocoagulation for diabetic macular edema can reduce the risk of moderate vision los...

Comparing the Effectiveness of Telemedicine and Traditional Surveillance in Providing Diabetic Retinopathy Screening Examinations: A Randomized Controlled Trial

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Development of a store-and-forward telescreening system of diabetic retinopathy: lessons learned from Iran

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Prevalencia de retinopatía diabética mediante cribado con retinógrafo no midriático

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