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Prateek Gajwani, Di Zhao, Eliseo Guallar, Madison Wahl, Jenina David, Niccolo Dosto, David S Friedman; Ungradable non mydriatic fundus photography in community eye screening. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5569. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate definitive exam findings in participants with ungradable fundus photos at community eye screenings
Individuals aged 50 years and older were screened at community sites in Baltimore, MD, and underwent non-mydriatic fundus photography using Nidek AFC 330 camera. Photos were evaluated onsite by the screener to determine gradability and presence of eye abnormalities. Participants were referred for a free follow-up eye exam if fundus photos were ungradable in either eye, or if the photos showed signs of abnormalities. During the definitive exam, an ophthalmologist examined each referred participant with a slit lamp and provided a final diagnosis. Among all referrals who attended definitive exams between October 2014 and May 2017, 136 (39.3%) participants were referred because of ungradable photos and were included in the analysis. A random sample of 190 participants referred with gradable photos for both eyes were included for comparison of definitive exam results. Multivariable logistic regression models were used to evaluate risk factors of ungradable photos
The proportion of participants who had an eye condition that would warrant a referral exam was lower for ungradable vs. gradable photos (41% vs. 70%), as well as participants with suspect or definite glaucoma (19% vs 52%, Table 1). Factors that were associated with higher odds of ungradable photos included older age (odds ratio 1.54 [95% CI 1.2, 2.0]), male sex (1.9 [1.1, 3.1]), and current smoking (3.6 [1.6, 8.0]). Factors that were associated with lower odds of ungradable photos were income ≥50k (0.2 [0.3, 0.9]), suspect (0.2 [0.1, 0.4]) or definite (0.1 [0.05, 0.4]) glaucoma, and intraocular pressure (0.8 [0.75, 0.9]), adjusting for demographic factors (Table 2).
Nonmydriatic cameras are unable to obtain gradable images in a substantial proportion of older, mostly African American individuals screened in the community. Participants referred for a definitive eye exam due to ungradable photos at community eye screenings had fewer eye problems than those referred for findings seen on gradable photos, but many had eye problems requiring care. Older age, male sex, current smoking, and lower income were associated with higher odds of ungradable images. Better technologies that reduce the proportion of ungradable images, thus lower over-referrals, would improve the efficiency of community screening for eye diseases.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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