Abstract
Purpose :
To study the validity and time required to detect diabetic retinopathy (DR) and sight threatening diabetic retinopathy (STDR) by using a hand-held electro-physiological tool compared to digital fundus photography.
Methods :
Patients with diabetes attending eye screening unit of King Khaled Eye Specialist Hospital were evaluated by electrophysiological test using ‘RETeval’ (LKC technologies Inc, USA), Amsler grid, and by digital dilated fundus photography (three fundus images per eye). The time required for testing was noted. Fundus images were evaluated by a retina specialist to determine grade of DR. The sensitivity and specificity of STDR and DR screening by ‘RETeval’ compared to photography were calculated, as well as ‘RETeval’ combined with Amsler grid testing.
Results :
We screened 269 diabetic patients. Digital images were not clear in 94 patients to decide DR stage, and they were excluded in validity analysis. The prevalence of STDR and DR was 35.4% and 57.5% respectively. The mean electro-physiological score obtained using ‘RETeval’ was 25.2±4.9 ms. The AUC in persons with STDR was 76.7% and in person with DR of any stage, it was 56%. Based on the criteria defined by the manufacturer, 25 (14.3%) patients passed the ‘RETeval’ test and 233 (85.7%) patients failed the test. The sensitivity and specificity of ‘RETeval’ test to detect STDR in either eye was 96.8% & 20.4% respectively. The sensitivity and specificity of ‘RETeval’ test to detect DR was 62.4% & 77.7%. The sensitivity and specificity of Amsler’s grid testing for STDR was 79% and 23%, respectively. The sensitivity of the combination of the two tests was 99%, and the specificity of STDR screening increased to 23% by doing sequential testing. The mean time for performing ‘RETeval’ was 5.7 ± 2.3 minutes. The median time for digital fundus photography was 15.3 minutes (25% quartile 10). In 48 (17.8%) patients who could not be assessed by digital fundus photography due to media opacities, one could undertake DR screening with ‘RETeval’.
Conclusions :
‘RETeval’ is a rapid screening device with excellent sensitivity for detecting STDR, and has potential as a 1st level screening tool to detect patients that require further evaluation. There is marginal improvement in the validity of the ‘RETeval’ screening test for STDR if it is combined with the Amsler’s test
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.