June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Monoscopic vs. Stereoscopic Optic Nerve Evaluation for Glaucomatous Features: Comparison of Ultrawide-field Scanning Laser Ophthalmoscopy and 35 mm Slide Photographs in a Diabetes Ocular Telemedicine Program
Author Affiliations & Notes
  • Brian J Song
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
    Ophthalmology, Harvard Medical School, Boston, MA
  • Louis R Pasquale
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
    Ophthalmology, Harvard Medical School, Boston, MA
  • Lloyd Paul Aiello
    Ophthalmology, Harvard Medical School, Boston, MA
    Beetham Eye Institute - Joslin Diabetes Center, Boston, MA
  • Paolo S Silva
    Ophthalmology, Harvard Medical School, Boston, MA
    Beetham Eye Institute - Joslin Diabetes Center, Boston, MA
  • Footnotes
    Commercial Relationships Brian Song, None; Louis Pasquale, None; Lloyd Paul Aiello, Optos PLC (F), Optos PLC (R); Paolo Silva, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 1023. doi:
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      Brian J Song, Louis R Pasquale, Lloyd Paul Aiello, Paolo S Silva; Monoscopic vs. Stereoscopic Optic Nerve Evaluation for Glaucomatous Features: Comparison of Ultrawide-field Scanning Laser Ophthalmoscopy and 35 mm Slide Photographs in a Diabetes Ocular Telemedicine Program. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1023.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To compare stereoscopic and monoscopic optic nerve images from diabetic (DM) subjects in an ocular telemedicine program for glaucomatous features using nonmydriatic, 200 degree ultrawide field imaging (UWFI) and mydriatic, 35 mm color slide photos (ETDRS field 1) and to assess UWFI stereographic projection on optic nerve analysis.

 
Methods
 

96 eyes of 48 DM subjects underwent UWFI and ETDRS photos at the same visit. Two independent, masked glaucoma specialists (BJS/LRP) graded structural optic nerve head and peripapillary features indicative of glaucoma. Disparities were adjudicated by consensus. Stereo- vs. monoscopic agreement was calculated using the weighted kappa (κ) statistic for cup/disc ratio (CDR) and unweighted κ for binary and categorical variables. Agreement was defined as poor (< 0.20), fair (0.21-0.40), moderate (0.41-0.60) or good (0.61-0.80). A subset of 18 stereographically projected, monoscopic, UWFI were compared to unprojected, stereoscopic UWFI.

 
Results
 

Mean age was 56±16 years; 56% male, 42% type 1 DM and mean DM duration 20±11 (3-49) years. Based on ETDRS photos (N=96 eyes), diabetic retinopathy (DR) was absent in 24%, mild nonproliferative DR (NPDR) in 32%, moderate NPDR in 38%, and severe/very severe NPDR in 6%. Mono- and stereoscopic optic nerve agreement for both modalities are shown in Table 1. Key features of each imaging modality are summarized in Table 2. Monoscopic evaluation for both modalities identified fewer glaucoma-suspicious optic nerves (-4.2% for UWFI and -8.4% for ETDRS photos) but these differences were not statistically significant (P>0.5).

 
Conclusions
 

These data suggest that UWFI can be utilized in telemedicine for disc evaluation of DM patients. In this cohort, there was good agreement between mono- and stereoscopic UWFI and monoscopic projected UWFI and stereoscopic ETDRS photos for CDR and suspicion of glaucoma. Stereographic projection of monoscopic UWFI did not appear to have a significant impact on optic nerve evaluation when compared to stereo ETDRS field 1. The potential effect and clinical relevance of UWFI optical distortion and projected correction on glaucoma evaluation requires further evaluation.  

 
Table 1. Mono- versus stereoscopic agreement. Values with κ > 0.60 are shown in bold.
 
Table 1. Mono- versus stereoscopic agreement. Values with κ > 0.60 are shown in bold.
 
 
Table 2. Summary of key features.
 
Table 2. Summary of key features.

 
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