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Dirk De Brouwere, Peter van Etten, Jose Martinez, Michiel Mensink; Efficient Early Diagnosis of Diabetic Retinopathy using zero-dilation Scanning Laser Ophthalmoscopy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5747.
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The incidence of diabetic retinopathy (DRP) is projected to escalate. Regular DRP screening of patients with diabetes enables early intervention and significantly reduces the risk of vision loss. However, increased demand has created a need for faster, more accessible technology. With a traditional fundus camera, mydriasis is recommended when the pupil diameter is 3.7 mm or less, but mydriasis is time-consuming, expensive and may cause discomfort. To counter this problem, a confocal line scanning laser ophthalmoscope (cLSLO) device has been developed for non-mydriatic diagnosis of DRP. We report data from a pilot study of cLSLO based diagnosis for DRP in the diabetic population in Rotterdam, in which we assessed whether cLSLO technology could achieve successful non-mydriatic imaging with a minimum pupil diameter of 2 mm.
100 diabetic patients (age 60 +/-11 y) were recruited for cLSLO imaging prior to eye examinations with a standard fundus camera at a diabetes center. The cLSLO device (EasyScan v1.2, i-Optics, Netherlands) uses green and infrared light to illuminate the retina through a 2 mm pupil, scanning over a 45 by 45 degree retinal field. After mydriasis, scheduled examinations with a fundus camera (Topcon NW-6) were performed. Pupil diameter was calculated and acquisition time was recorded. Referral for DRP was assessed by two licensed graders based on images of both devices. Both interobserver agreement and agreements between both instruments was analysed
In this cohort of patients, gradeability of cLSLO images is in line with the criteria for diabetic diagnosis devices specified by the British diabetic association (BDA). 56% of the population had at least one pupil with diameter less than 3.7 mm and would require mydriasis for traditional fundus camera imaging. Average image acquisition time was less than 3 minutes.
In summary, cLSLO imaging provides an efficient technology that can be used for DRP diagnosis without mydriasis, which may enable a reduction in appointment times, with consequent benefits for both patients and healthcare providers.
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