Detection of Retinal Detachment by ED Clinicians on OCT Images versus Fundus Photos

Abstract

Purpose : Retinal detachment (RD) is an ocular emergency that can quickly progress to complete loss of vision without prompt diagnosis and treatment. Current standard of care in the emergency department (ED) is to examine the fundus with a direct ophthalmoscope, a difficult-to-use instrument with a limited en face view. Optical coherence tomography (OCT) is a promising alternative that offers cross-sectional images of the retina with micrometer resolution. This study tested the hypothesis that ED clinicians can detect RD with greater sensitivity and specificity on OCT images versus en face fundus photographs.

Methods : A retrospective dataset was assembled from 55 eyes (30 with RD, 25 without RD) recently treated at Duke Eye Center. One fundus photo and one paired OCT image were used from each eye for a total of 110 images (Figure 1). All images were acquired and interpreted by retina specialists as part of routine clinical care. Nine ED clinicians at Duke Health participated in this study. Each clinician first reviewed a handout on the detection of RD on fundus photos and OCT images, and then evaluated all 110 images for the presence of RD. Sensitivity and specificity were calculated for each imaging modality using the retina specialists’ prior interpretations as the gold standard. Wilcoxon signed-rank test (WSRT) was used to compare the paired differences between fundus photos and OCT images.

Results : ED clinicians achieved 97% sensitivity and 93% specificity on OCT images as compared to 75% sensitivity and 96% specificity on fundus photos (Table 1). WSRT indicated that sensitivity on OCT was statistically significantly higher than sensitivity on fundus photos (z = 0, p = 0.0039). There was no significant difference in specificities between OCT and fundus photos (z = 4, p = 0.7500).

Conclusions : ED clinicians detected RD with greater sensitivity on OCT images than on fundus photos. Both imaging modalities had high specificities with no significant difference. These findings suggest that OCT could have excellent diagnostic potential in the ED, at minimum as a highly sensitive screening test for RD.

This is a 2020 ARVO Annual Meeting abstract.

 

Figure 1. (A) Fundus photo of an eye without retinal detachment (RD). (B) Paired OCT image of the same eye as in (A) without RD. (C) Fundus photo of an eye with RD. (D) Paired OCT image of the same eye as in (C) with RD.

 

Table 1. Comparison between ED and Ophthalmology Findings on Fundus Photos and OCT Images