Nondiabetic Retinal Findings Using Ultrawide Field Imaging in a Diabetes Ocular Telehealth Program

Abstract

Purpose: To assess nonmydriatic ultrawide field retinal imaging (UWFI) as compared to nonmydriatic fundus photography (NMFP) for identification of nondiabetic retinal (nonDR) findings

Methods: Retrospective, comparative cohort study of patients imaged from 1/1/2011 to 6/30/2013. Images were evaluated stereoscopically. In addition to diabetic retinopathy (DR) severity, certified graders performed standardized evaluation of nonDR retinal findings and the optic nerve head (ONH) for both imaging modalities.

Results: 3,859 and 3,964 consecutive patients were imaged using NMFP and UWFI, respectively. There were no statistically significant differences between groups in age, gender, ethnicity or insulin use. Patients with UWFI had longer diabetes duration compared to patients imaged with NMFP (13 years vs 12 years, p<0.0004). NMFP and UWFI identified at least 1 nonDR finding in 19% (726) and 21% (832) of patients, respectively (p=0.02). In patients without DR (NMFP: N=2239; UWFI: N=2251), nonDR findings were present in 20% (451) of patients imaged with NMFP and 22% (490) with UWFI (p=0.18). Identification of choroidal nevi (5% vs 7%, p<0.001) and chorioretinal atrophy or scarring (0.6% vs 1.3%, p<0.0001) was increased with UWFI. As compared with no cases using NMFP, UWFI detected a total of 25 retinal tears (0.3%, p<0.0001), 32 lattice and peripheral degenerations (0.4%, P<0.0001) and 141 vitreous detachment or floaters (1.8%, p<0.0001). Suspicion for glaucoma based on ONH evaluation arose in 9% (675) of eyes imaged with NMFP and 10% (781) with UWFI. No significant differences were noted for findings such as macular degeneration, hypertensive retinopathy, retinal vein occlusion, retinal emboli, macular holes and asteroid hyalosis.

Conclusions: Over 20% of diabetic patients had nonDR retinal findings by UWFI. UWFI significantly increased the identification of nonDR findings, especially retinal tears, choroidal lesions and other peripheral pathology. Given the unique benefits of UWFI in diabetes ocular telehealth programs, the fact that 22% of patients had nonDR findings by UWFI even when no DR was present, further emphasizes the role of such evaluation regardless of DR severity

Keywords: 550 imaging/image analysis: clinical • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 688 retina