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K. Brown, J. Sewell, T. Travison; Enhancement of Retinal Lesion Detection Using P200C Scanning Laser Ophthalmoscopy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2302.
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Anecdotal information suggests that non-mydriatic imaging is being offered by some as an alternative to routine dilation, despite limited evidence that these devices are equivalent to a dilated clinical exam. A pilot study compared the sensitivity and specificity of traditional dilated exam with Optomap image review and targeted ophthalmoscopy using a P200C SLO for retinal lesion detection.
40 subjects age 58.9 (SD 14.3) years, (65% female) underwent non-mydriatic imaging with a P200C SLO. Subjects were then dilated and underwent a traditional dilated exam and targeted ophthalmoscopy by different examiners. In targeted ophthalmoscopy, Optomap images were reviewed by the examiner in conjunction with the dilated exam. Images were manipulated to enhance visualization of retinal features by adjusting review software tools e.g. zoom, contrast, and exposure levels of red and green channels. Lesions detected by traditional dilated exam and targeted opthalmoscopy were recorded and discrepencies were adjudicated by a retinal specialist. Images were reviewed by a masked Reader who recorded the lesions seen only in the Optomap images. Lesions were grouped into 1 of 3 regions: Optic Nerve, Macula/Posterior Pole and Mid-to-Peripheral Retina.
Overall sensitivity of Optomap image review and targeted ophthalmoscopy was higher than traditional dilated exam by about 13% and 30% respectively; particularly in the mid-peripheral retina (Table 1). Specificity was similar across all methods, (92.2%-96.8%).
Targeted ophthalmoscopy may enhance detection of lesions, especially in the mid to peripheral retina. A wide-field perspective and ability to manipulate images with P200C software may explain why. Pilot results are to be interpreted with caution. Results and analysis from a larger study of 171 subjects will be available by May 2010.
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