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Published Online: 6 September 2012

Comparison of Low-Light Nonmydriatic Digital Imaging with 35-mm ETDRS Seven-Standard Field Stereo Color Fundus Photographs and Clinical Examination

Publication: Telemedicine and e-Health
Volume 18, Issue Number 7

Abstract

Purpose: To compare agreement between diagnosis of clinical level of diabetic retinopathy (DR) and diabetic macular edema (DME) derived from nonmydriatic fundus images using a digital camera back optimized for low-flash image capture (MegaVision) compared with standard seven-field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs and dilated clinical examination. Subject comfort and image acquisition time were also evaluated. Subjects and Methods: In total, 126 eyes from 67 subjects with diabetes underwent Joslin Vision Network nonmydriatic retinal imaging. ETDRS photographs were obtained after pupillary dilation, and fundus examination was performed by a retina specialist. Results: There was near-perfect agreement between MegaVision and ETDRS photographs (κ=0.81, 95% confidence interval [CI] 0.73–0.89) for clinical DR severity levels. Substantial agreement was observed with clinical examination (κ=0.71, 95% CI 0.62–0.80). For DME severity level there was near-perfect agreement with ETDRS photographs (κ=0.92, 95% CI 0.87–0.98) and moderate agreement with clinical examination (κ=0.58, 95% CI 0.46–0.71). The wider MegaVision 45° field led to identification of nonproliferative changes in areas not imaged by the 30° field of ETDRS photos. Field area unique to ETDRS photographs identified proliferative changes not visualized with MegaVision. Mean MegaVision acquisition time was 9:52 min. After imaging, 60% of subjects preferred the MegaVision lower flash settings. Conclusions: When evaluated using a rigorous protocol, images captured using a low-light digital camera compared favorably with ETDRS photography and clinical examination for grading level of DR and DME. Furthermore, these data suggest the importance of more extensive peripheral images and suggest that utilization of wide-field retinal imaging may further improve accuracy of DR assessment.

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Information & Authors

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Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 18Issue Number 7September 2012
Pages: 492 - 499
PubMed: 22827402

History

Published online: 6 September 2012
Published in print: September 2012
Published ahead of print: 24 July 2012
Accepted: 16 December 2011
Received: 4 November 2011

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Paolo S. Silva
*
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Saloni Walia*
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Jerry D. Cavallerano
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Jennifer K. Sun
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Cheri Dunn
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Sven-Erik Bursell
Telehealth Research Institute, University of Hawaii, Honolulu, Hawaii.
Lloyd M. Aiello
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Lloyd Paul Aiello
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

Notes

Address correspondence to:Lloyd Paul Aiello, M.D., Ph.D.Beetham Eye InstituteJoslin Diabetes Center1 Joslin PlaceBoston, MA 02215E-mail: [email protected]
The content of the information within this article does not necessarily reflect the position or the policy of the government, and no official endorsement should be inferred.

Disclosure Statement

No competing financial interests exist. The authors have no financial relationship with MegaVision.

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