June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Impact of Ultrawide Field Retinal Imaging (UWFI) on the Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy(RAAB-DR) Survey
Author Affiliations & Notes
  • Gary L. Yau
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Leo DP Cubillan
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Karlo Marco D. Claudio
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Kevin Mathew B. Panggat
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Migil G. Ledesma
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Maria Angelica DF Villano
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Joanne Christine E. Macenas
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Cloyd M. Pitoc
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Carisa Mariella A. Paraz
    University of the Philippines, Philippine Eye Research Institute , Manila, Philippines
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Gary Yau, None; Paolo Silva, Optos (F); Leo Cubillan, None; Karlo Claudio, None; Kevin Panggat, None; Migil Ledesma, None; Maria Villano, None; Joanne Macenas, None; Cloyd Pitoc, None; Carisa Paraz, None; Jennifer Sun, None; Lloyd Aiello, Optos (R), Optos (F)
  • Footnotes
    Support  Lions International
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5450. doi:
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      Gary L. Yau, Paolo Sandico Silva, Leo DP Cubillan, Karlo Marco D. Claudio, Kevin Mathew B. Panggat, Migil G. Ledesma, Maria Angelica DF Villano, Joanne Christine E. Macenas, Cloyd M. Pitoc, Carisa Mariella A. Paraz, Jennifer K Sun, Lloyd P Aiello; Impact of Ultrawide Field Retinal Imaging (UWFI) on the Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy(RAAB-DR) Survey. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5450.

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

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Abstract

Purpose : To evaluate the feasibility and benefit of implementing UWFI within the efficient and cost-effective survey method of RAAB-DR used to estimate prevalence and causes of visual impairment(VI) in Central Luzon, Philippines

Methods : The RAAB-DR methodology estimates the prevalence of blindness, diabetes mellitus (DM) and DR in a defined geographic area. Community clusters(N=35) each with 50 subjects >=50 yrs old were selected by probability proportionate to size sampling for entry into this cross-sectional population-based survey. Participants received visual acuity(VA) screening and VI diagnosis by a study certified ophthalmologist. Subjects were classified as having DM if they had a previous diagnosis, were receiving DM treatment or had HbA1c >=6.5%. DM subjects were further assessed for DR by dilated biomicroscopy(direct and indirect). All subjects had nonmydriatic UWFI(2 stereo 200o images/eye; Daytona, Optos plc, Scotland, UK). Retinal images were evaluated by Joslin Vision Network protocol at a centralized reading center. Main outcome measures were prevalence and primary causes of VI(<20/40), prevalence of DR based on UWFI, and agreement between UWFI and dilated biomicroscopy for DR severity.

Results : 1750 individuals were identified and 1440(82.3%) evaluated. VA was >=20/40 in 1090(75.1%). The 3 top causes of VA <20/40 were untreated cataracts(n=219,62%), refractive error(n=81,23%) and posterior segment disease(n=27,8%). UWFI was done in 1358 subjects(94.3%), with ungradable images in 22(1.6%). Non-DR posterior segment disease was identified in 341(23.7%) and DM found in 377(26.1%) subjects. DR severity distribution(by UWFI) was: no DR=69.5%, mild non-proliferative DR(NPDR)=11.1%, moderate NPDR=9.3%, severe NPDR=2.7%, proliferative DR=5.0%, DME=5.6% and ungradable=2.4%. Linear-weighted DR severity agreement between UWFI and dilated biomicroscopic exam was substantial(k=0.64,95% CI,0.56-0.72), with exact agreement in 75.8% and within 1-step in 95.4%. UWFI identified more severe disease in 17.8%.

Conclusions : Relatively high rates of DM and DR are found in this diverse low-to-middle income population. As the first RAAB-DR survey to use UWFI, our study demonstrates that UWFI can be readily incorporated, has substantial agreement with biomicroscopy and appears to improve the ability to identify DR and non-DR retinal disease in such population-based surveys.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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