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Andrew Want, Rebecca Rewbury, Rachel Varughese, Victor Chong; Classification of Diabetic Macular Edema Based on the Morphology in Optical Coherent Topography. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3423.
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To evaluate a new classification of diabetic macular edema (DME) based on the morphology in spectral domain optical coherent topography (SD-OCT). Several suggestions with time-domain OCT have previously been put forward however there is currently no widely acceptable system for SD-OCT. Any new classification should be practical, accessible and able to be used by practitioners without specialist retinal training
This study was approved by the local Ethics Committee. A complete list of all patients who had attended the diabetic eye clinic at Oxford Eye Hospital between January 2012 and February 2013 was collected. We have included only type II diabetics, with a documented history of foveal involving DME in at least one eye, no prior treatment, and without any other retinal pathologies. Two masked individuals, who did not have specialist retinal training, graded the Heidelberg Spectralis SD-OCT images for these patients. Disagreement was checked by a senior retinal specialist to ensure the images were graded accurately. Grade 1 - presence of serous retinal detachment Grade 2 - presence of single, central retinal cyst Grade 3 - presence of multiple retinal edema with eversion of the fovea Grade 4 - presence of multiple retinal edema, without eversion the fovea
247 OCT images were included. Grade 1 - 22 images (8.91%), Grade 2 - 13 images (5.26%) Grade 3 - 110 images (44.53%) Grade 4 - 102 images (41.30%) The main disagreement on grading was on whether there was foveal eversion or not.
The grading system was successfully used by individuals who did not have expertise in ophthalmology, and the spread of results also suggests that it is a practical system when applied to a large sample of images. This system will now be used as the basis of a subsequent prospective study assessing whether this grading system could be used as an indicator for response to treatment.
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