June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Addition of Mid-peripheral Fields to 2-Field Disc and Macula Handheld Retinal Images Improves Agreement with Early Treatment Diabetic Retinopathy Study (ETDRS) 7-Standard Field Photography
Author Affiliations & Notes
  • Claude Michael Garcia Salva
    Philippine Eye Research Institute, University of the Philippines Manila, Manila, Metro Manila, Philippines
  • Lizzie Anne Aquino
    Philippine Eye Research Institute, University of the Philippines Manila, Manila, Metro Manila, Philippines
  • Recivall Pascual Salongcay
    Philippine Eye Research Institute, University of the Philippines Manila, Manila, Metro Manila, Philippines
    Centre for Public Health, Queen's University Belfast, Belfast, Belfast, United Kingdom
  • Aileen Viguilla Saunar
    Philippine Eye Research Institute, University of the Philippines Manila, Manila, Metro Manila, Philippines
  • Glenn P Alog
    Philippine Eye Research Institute, University of the Philippines Manila, Manila, Metro Manila, Philippines
  • Tunde Peto
    Centre for Public Health, Queen's University Belfast, Belfast, Belfast, United Kingdom
  • Lloyd Paul Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo S Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Claude Michael Salva, None; Lizzie Anne Aquino, None; Recivall Salongcay, None; Aileen Saunar, None; Glenn Alog, None; Tunde Peto, None; Lloyd Aiello, None; Paolo Silva, Hill-Rom (F), OptoMed (F), Optos (F)
  • Footnotes
    Support  Newton-Agham Fund
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1112. doi:
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      Claude Michael Garcia Salva, Lizzie Anne Aquino, Recivall Pascual Salongcay, Aileen Viguilla Saunar, Glenn P Alog, Tunde Peto, Lloyd Paul Aiello, Paolo S Silva; Addition of Mid-peripheral Fields to 2-Field Disc and Macula Handheld Retinal Images Improves Agreement with Early Treatment Diabetic Retinopathy Study (ETDRS) 7-Standard Field Photography. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1112.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine benefit of 5-field (5F) vs 2-field (2F) mydriatic handheld retinal imaging for assessment of diabetic retinopathy (DR) as compared with standard ETDRS 7-field 300 fundus photographs (ETDRS photos).

Methods : Following standard imaging protocol, 5 fields (macula, disc, superior, inferior and nasal) were acquired using 2 handheld retinal cameras [Aurora (AU), Smartscope (SS)] and ETDRS photos following pupil dilation (Figure 1). Images were evaluated at a centralized reading center independently by masked graders (International DR Classification). Simple (K) and weighted (KW) kappa statistics assessed agreement for DR. Sensitivity and specificity for any DR, referable DR [(refDR) moderate nonproliferative DR (NPDR) or worse, any DME or ungradable images] and vision threatening DR [(vtDR) severe NPDR or worse, clinically significant DME (CSME) or ungradable images] were calculated.

Results : Images from 177 eyes of 92 patients with diabetes were evaluated. By ETDRS photos: No DR 40.1% eyes, mild NPDR 19.2%, moderate 14.7%, severe 10.2%, proliferative DR 15.8%; No DME 72.9% eyes, DME 6.8%, CSME 17.0%; ungradable 3.4%. Ungradable rate for DR: AU, 2F:1.1%, 5F:0%; SS, 2F:5.0%, 5F: 4.5%; and DME: AU:10.2%, SS:13.0%. DR agreement with ETDRS photos are shown in table 1. 5F imaging increased exact agreement w/ ETDRS photos by 32.5% AU and 19.8% SS and w/in 1-step by 8.9% AU, 6.6% SS. 5F imaging increased k agreement w/ ETDRS photos for DR from moderate to substantial for both AU and SS. Reliability indices are shown in table 1. 5F imaging increased sensitivity for any DR, refDR and vtDR on both AU (0.76 to 0.97, 0.78 to 0.88, 0.83 to 0.86) and SS (0.79 to 0.82, 0.79 to 0.87, 0.83 to 0.89).

Conclusions : The peripheral fields obtained using a 5F protocol with 2 handheld retinal cameras substantially increased agreement with ETDRS-determined DR as compared with only posterior 2F imaging. Sensitivity increased while maintaining specificity for identifying refDR and vtDR. The observed DR grading agreement between 5F handheld imaging and ETDRS photos suggests that handheld retinal imaging performed in this manner may be accurate enough for DR screening programs, where their size, cost and ease of use attributes would allow them to be widely deployed in community-based DR screening programs.

This is a 2021 ARVO Annual Meeting abstract.

 

 

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