Abstract
Purpose :
To determine the effect of integrating point-of-care macular spectral domain optical coherence tomography (SDOCT) within a diabetic retinopathy (DR) ultrawide field (UWF) retinal imaging telemedicine program using Monaco device (Optos, plc).
Methods :
This retrospective, comparative cohort study evaluated consecutively imaged patients from 1/8/2020 to 3/16/2020 at an UWF image-based DR teleophthalmology program. Both UWF photos and SD-OCT images were acquired using the same instrument at the same session. UWF photos were assessed for DR and DME by a centralized reading center grader masked to SDOCT findings. OCT images were evaluated using standardized templates by a grader masked to UWF photos and findings. Normative OCT measures are currently not available for the Monaco, thus SDOCT scans were evaluated qualitatively for macular pathology (DME, epiretinal membrane [ERM], pigment epithelial detachment, neovascular macular degeneration, tractional retinal detachment). Reliability indices were calculated with SDOCT as gold standard.
Results :
422 eyes from 211 diabetic patients were evaluated. Severity by UWF grading: No DR 57.8%, mild NPDR 30.3%, moderate 7.1%, severe 1.7%, proliferative 2.4%, ungradable 0.7%; no DME 93.4%, non-ciDME 5.2%, ciDME 0.7%, ungradable 0.7%. SDOCT was ungradable in 0.5%. The distribution of macular pathology observed on UWF and SDOCT is shown in Table 1. SDOCT identified 5 (25%) non-ciDME, 9 ciDME (75%) and 28 (97%) ERM eyes that were undetected on UWF. SDOCT did not confirm 14 (56%) non-ciDME, 2 ciDME (67%) and 9 (90%) ERM eyes identified on UWF. Reliability indices are presented in table 2.
Conclusions :
Addition of SDOCT increased the identification of macular pathology by 62%. DME and ERM represented 36% and 53% of SD-OCT identified referable macular pathology, respectively. Only 27.3% of eyes with ciDME and only 3.4% with ERM present on SDOCT were identified on UWF imaging. The integration of SDOCT with UWF imaging markedly increased detection and reduced false positive assessments of DME and ERM in a large-scale DR screening program. Given the reduced effort, compact footprint and reduced overall cost of integrated SDOCT/UWF devices, their use in large DR screening programs could substantially improve disease identification and improve visual outcomes.
This is a 2021 ARVO Annual Meeting abstract.