Comparison Between Digital Fundus Imaging and Fundus Examination in Treatment Recommendations for Diabetic Retinopathy

Abstract

Abstract: : Purpose: To determine the agreement between mydriatic fundus imaging and funduscopic examination in managing diabetic retinopathy in a mainly resident- and fellow-staffed eye clinic. Methods: In this prospective, masked study, 41 consecutive diabetic patients that presented to the Louisiana State University Retina and Eye Clinics at Medical Center of Louisiana New Orleans underwent 1) complete ophthalmologic examinations by residents, confirmed by one first-year retina fellow (reviewer A), with dilated biomicroscopic funduscopy and 2) mydriatic fundus imaging (same 7 fields as the modified Airlie House recommendations but using 45^o fields) by one trained ophthalmic technician or one photographer with a Topcon digital (800x600 pixel) camera. Images were graded by a 3rd year ophthalmology resident (reviewer B) and a staff retina attending (reviewer C) in masked fashion. All reviewers (A, B, and C) remained masked. Agreement for patient management between reviewers A and B, B and C, and A and C was determined using kappa analysis for the following criteria: 1) treatment plan (laser, consult, or visual field), 2) clinic of follow-up (Eye, Retina, or other), and 3) time of follow-up. Results: Kappa analyses showed good agreement for treatment plan between reviewers B and C (k=0.62), and moderately good agreement for clinic of follow-up (k=0.41) and time of follow-up (k=0.34). Poor agreement existed between either reviewer of fundus images (reviewer B or C) and fundus examination (reviewer A) for all three criteria (k<0.25). Conclusions: Despite relatively good agreement between staff and resident recommendations for diabetic retinopathy management as determined by review of fundus images, poor agreement existed for criteria tested between fundus examination and review of retinal images. Use of retinal imaging may improve treatment recommendations for diabetic retinopathy in a primarily resident- and fellow-staffed clinic setting.

Keywords: clinical (human) or epidemiologic studies: sys • diabetic retinopathy • imaging/image analysis: clinical