Wide-field imaging and OCT vs clinical evaluation of patients referred from diabetic retinopathy screening

Abstract

PurposeCompare wide-field Optomap imaging and optical coherence tomography (OCT) with clinical examination in diabetic retinopathy (DR).MethodsPatients referred from Diabetic Eye Screening Programmes to three centres underwent dilated ophthalmoscopy and were assigned a DR grade. Wide-field colour imaging and OCT were then examined by the same clinician at that visit and a combined grade was assigned. Independent graders later reviewed the images and assigned an imaging-only grade. These three grades (clinical, combined, and imaging) were compared. The method that detected the highest grade of retinopathy, including neovascularisation, was determined.ResultsTwo thousand and forty eyes of 1023 patients were assessed. Wide-field imaging compared with clinical examination had a sensitivity and specificity of 73% and 96%, respectively, for detecting proliferative DR, 84% and 69% for sight-threatening DR, and 64% and 90% for diabetic macular oedema. Imaging alone found 35 more eyes with new vessels (19% of eyes with new vessels) and the combined grade found 14 more eyes than clinical examination alone.ConclusionsAssessment of wide-field images and OCT alone detected more eyes with higher grades of DR compared with clinical examination alone or when combined with imaging in a clinical setting. The sensitivity was not higher as the techniques were not the same, with imaging alone being more sensitive. Wide-field imaging with OCT could be used to assess referrals from DR screening to determine management, to enhance the quality of assessment in clinics, and to follow-up patients whose DR is above the screening referral threshold but does not actually require treatment.

Clinical Application of Multicolor Imaging Technology

“…Other studies have tested and modified screening protocols using nonmydriatic imaging, single-field imaging and automated detection systems with variable results [3,4,20,21,22]. A recent study using wide-field imaging and OCT showed improvements in the detection rates of higher grades of diabetic retinopathy compared to clinical examination [23]. From the ophthalmologist perspective, an advantage of the multicolor imaging on the combined cSLO + SD-OCT platform is that a single device can perform all imaging modalities required.…”

Does delay in referral of proliferative diabetic retinopathy from the diabetic eye screening programme lead to visual loss?

“…6 New technologies, such as wide-field imaging and OCT, being introduced routinely into HES, are improving accuracy of diagnoses. 7 Wide-field imaging detects more new vessels in more patients than the standard two 45°images used by the DESP. 8 These differences in diagnosis continue to challenge both graders and ophthalmologists, but can be resolved with a better understanding of the processes in each service and with better communication between them.…”

Wide-field Imaging of Retinal Diseases

“…9 One study showed that Optomap imaging enabled earlier diagnosis of higher grades of diabetic retinopathy compared with clinicians performing slit lamp biomicroscopy of the fundus. 10 Similarly, wide-field imaging has been shown to capture more retinal nonperfusion, neovascularization, and panretinal photocoagulation than the seven-standard fields obtained by the ETDRS protocol (see Figure 3). Wessel et al reviewed 236 Optos…”