Abstract
Purpose :
To determine whether the use Optical coherence tomography(OCT) imaging in a primary care diabetic retinopathy telemedicine screening service can improve the detection of diabetic macular edema(DME).
Methods :
Patients were recruited from a primary care diabetic retinopathy telemedicine screening service. Participants had non-stereoscopic macular and disc centered fundus photographs(FP) taken in each eye; and had spectral domain optical coherence tomography imaging performed. All Images were sent via telemedicine to a centralized reading centre. FP were graded with the standard reading center protocol, blinded to the OCT results. OCT images were graded independently by a trained grader at a centralized reading centre.(grader OCT) Images were subsequently reviewed by a retina specialist for DME diagnosis. Medical records for those referred for ophthalmologist assessment were reviewed.
Results :
502 patients agreed to participate in this study (62% Male). The mean duration of diabetes was 7.2 (SD+/-7.9) years and the mean Glycated hemoglobin(HbA1c) was 7.6 (SD+/-1.7)%. There were 15 (3.0%) subjects identified with DME by Retina specialist assessment. Telemedicine screening identified 26 DME subjects with FP alone and 22 DME subjects with grader OCT. Compared with the retina specialist assessment, FP had a Sensitivity of 0.533 (95% CI: 0.301 to 0.752), Specificity of 0.963 (95% CI: 0.942 to 0.977), Positive predictive value(PPV) 30.7% and negative predictive value(NPV) 95.3%. Grader OCT had a Sensitivity of 1.00 (95% CI: 0.796 to 1.00), Specificity of 0.986 (95% CI: 0.971 to 0.993), PPV 68.2% and NPV 100%. Grader OCT identified 4 cases of DME (26.7%) that were missed on FP. Those with DME had higher HbA1c (p<0.001) but similar duration of diabetes compared to those without DME.
Conclusions :
This data suggest that adding OCT to a telemedicine diabetic retinopathy screening program can improve the accuracy of detection of DME. This will ensure that the correct patients with diabetes are identified for specialist care where appropriate management can improve their future visual outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.