June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Integrating Macular Optical Coherence Tomography with Ultrawide Field Imaging in a Diabetic Retinopathy Telemedicine Program Using a Single Device
Author Affiliations & Notes
  • Lloyd Paul Aiello
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Cris Martin P. Jacoba
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Jennifer K Sun
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo S Silva
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Lloyd Aiello, KalVista (F), KalVista (I), Novo Nordisk (F); Cris Jacoba, None; Jennifer Sun, Optovue (F); Paolo Silva, Hill-rom (F), Optomed (F), Optos plc (F)
  • Footnotes
    Support  Massachusetts Lions Eye Research Fund
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1941. doi:
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    • Get Citation

      Lloyd Paul Aiello, Cris Martin P. Jacoba, Jennifer K Sun, Paolo S Silva; Integrating Macular Optical Coherence Tomography with Ultrawide Field Imaging in a Diabetic Retinopathy Telemedicine Program Using a Single Device. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1941.

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

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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.

 

 

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