Abstract
Purpose :
Prior studies have established ultra-widefield imaging in the assessment of diabetic retinopathy. The primary aim of this study was to determine its use, compared to slit lamp biomicroscopy, for the detection of fundus pathology in a routine patient population.
Methods :
In this prospective randomized study, patients underwent biomicroscopy by certified optometrists and ultra-widefield imaging. Ultra-widefield photos were independently graded by two optometrists. Clinical findings from examiners and photo-graders were coded into themes using inductive thematic analysis, and then clinically significant findings were extracted. Discrepancies between photo-graders were adjudicated by a retinal ophthalmologist to create a consensus interpretation. Cohen’s kappa was used to estimate agreement between the two photo-graders and between the examinations and photo-grades.
Results :
Nine-hundred eyes of 450 patients were examined and imaged. Of the clinically significant examination findings, inter-photo-grader agreement was moderate to substantial for most, including optic disc hemorrhage (k = 0.8), macular exudates (k = 0.7), and macular pigmentary changes (k = 0.7). Agreement between examination and photo-grades was moderate to substantial for optic disc hemorrhage (k = 1), indistinct optic disc margins (k = 0.5), macular drusen (k = 0.4), and peripheral retinal pigmentary changes (k = 0.4), drusen (k = 0.4), and hemorrhage (k = 0.8). A total of 187 findings were detected by imaging but not examination, compared with 42 that were detected on examination but not imaging.
Conclusions :
Ultra-widefield imaging agreed substantially with standard-of-care examinations in a routine patient population and detected more fundus findings than clinical examination.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.