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Alexander C. Walsh, Florian M. Heussen, Srinivas R. Sadda, Yanling Ouyang; Prospective Comparison of Nonmydriatic Imaging and 3D Optical Coherence Tomography (3D-OCT) for Detecting Retinal Abnormalities. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2176.
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Nonmydriatic imaging has risen in popularity for retinal disease screening despite its well-known shortcomings. Optical coherence tomography (OCT) has potential advantages over flood imaging and is ubiquitous in clinical practice. This study investigates the sensitivity of 3D-OCT versus nonmydriatic imaging in the detection of retinal lesions in asymptomatic individuals.
Asymptomatic subjects (i.e. patient companions) were prospectively recruited from our clinic waiting room over six months. Each subject completed a questionnaire prior to the acquisition of two undilated 45º fundus images and 4 undilated raster 3D-OCT scans (3x512x128, 1x1024x64) covering the macula and optic nerve of each eye using a 3D-OCT-1000 (Topcon Co, Tokyo). Two graders evaluated the fundus images for abnormalities within (infield) or outside (anyfield) the OCT field of view. 3D-OCT scans were assessed for abnormalities in five categories (Table 1). Detection sensitivities were compared between the two modalities using the appearance of the abnormality in either modality as the ground truth.
284 eyes from 144 subjects were included in the study. The mean age was 38.1 years (range 18-77 yrs). 43% of subjects had one or more abnormalities identified. 3D-OCT was more sensitive than nonmydriatic imaging for the detection of every abnormality category in this study (Table 1). This was true even when including fundus image findings outside of the OCT scan field (anyfield). 7% of fundus images were ungradable and 62% had artifacts compared to 0.4% of OCT images.
In this study, 3D-OCT had up to six times higher sensitivity than nonmydriatic imaging for detection of retinal abnormalities. OCT detected critical disease features, such a subretinal fluid, that were missed by nonmydriatic imaging and had a lower ungradable image rate. OCT may be a more sensitive, comfortable, and adaptable method of screening for eye disease.
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