Comparisons of Handheld Retinal Imaging with Optical Coherence Tomography for the Identification of Macular Pathology in Patients with Diabetes.

IF 2 4区医学 Q2 OPHTHALMOLOGY Ophthalmic Research Pub Date : 2023-01-01 Epub Date: 2023-04-20 DOI:10.1159/000530720

Cris Martin P Jacoba, Recivall P Salongcay, Abdulrahman K Rageh, Lizzie Anne C Aquino, Glenn P Alog, Aileen V Saunar, Tunde Peto, Paolo S Silva

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Abstract

Introduction: Handheld retinal imaging cameras are relatively inexpensive and highly portable devices that have the potential to significantly expand diabetic retinopathy (DR) screening, allowing a much broader population to be evaluated. However, it is essential to evaluate if these devices can accurately identify vision-threatening macular diseases if DR screening programs will rely on these instruments. Thus, the purpose of this study was to evaluate the detection of diabetic macular pathology using monoscopic macula-centered images using mydriatic handheld retinal imaging compared with spectral domain optical coherence tomography (SDOCT).

Methods: Mydriatic 40°-60° macula-centered images taken with 3 handheld retinal imaging devices (Aurora [AU], SmartScope [SS], RetinaVue 700 [RV]) were compared with the Cirrus 6000 SDOCT taken during the same visit. Images were evaluated for the presence of diabetic macular edema (DME) on monoscopic fundus photographs adapted from Early Treatment Diabetic Retinopathy Study (ETDRS) definitions (no DME, noncenter-involved DME [non-ciDME], and center-involved DME [ciDME]). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each device with SDOCT as gold standard.

Results: Severity by ETDRS photos: no DR 33.3%, mild NPDR 20.4%, moderate 14.2%, severe 11.6%, proliferative 20.4%, and ungradable for DR 0%; no DME 83.1%, non-ciDME 4.9%, ciDME 12.0%, and ungradable for DME 0%. Gradable images by SDOCT (N = 217, 96.4%) showed no DME in 75.6%, non-ciDME in 9.8%, and ciDME in 11.1%. The ungradable rate for images (poor visualization in >50% of the macula) was AU: 0.9%, SS: 4.4%, and RV: 6.2%. For DME, sensitivity and specificity were similar across devices (0.5-0.64, 0.93-0.97). For nondiabetic macular pathology (ERM, pigment epithelial detachment, traction retinal detachment) across all devices, sensitivity was low to moderate (0.2-0.5) but highly specific (0.93-1.00).

Conclusions: Compared to SDOCT, handheld macular imaging attained high specificity but low sensitivity in identifying macular pathology. This suggests the importance of SDOCT evaluation for patients suspected to have DME on fundus photography, leading to more appropriate referral refinement.

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手持式视网膜成像与光学相干断层扫描在糖尿病患者黄斑病理学鉴定中的比较。

简介：手持式视网膜成像相机是一种相对便宜且高度便携的设备，有可能显著扩大糖尿病视网膜病变（DR）筛查，从而对更广泛的人群进行评估。然而，如果DR筛查项目将依赖于这些仪器，那么评估这些设备是否能够准确识别威胁视力的黄斑疾病是至关重要的。因此，本研究的目的是评估与光谱域光学相干断层扫描（SDOCT）相比，使用散瞳手持视网膜成像的单视野黄斑中心图像检测糖尿病黄斑病变的效果。方法：将3台手持视网膜成像设备（Aurora[AU]、SmartScope[SS]、RetinaVue700[RV]）拍摄的以Mydriatic 40°-60°黄斑为中心的图像与同一次就诊期间拍摄的Cirrus 6000 SDOCT进行比较。根据早期治疗糖尿病视网膜病变研究（ETDRS）的定义（无DME、非中心受累DME[非ciDME]和中心受累DMM[ciDME'），在单视野眼底照片上评估图像是否存在糖尿病黄斑水肿（DME）。以SDOCT为金标准，计算每个装置的灵敏度、特异性、阳性预测值和阴性预测值。结果：ETDRS照片的严重程度：无DR 33.3%，轻度NPDR 20.4%，中度14.2%，重度11.6%，增殖性20.4%，DR不可分级0%；无DME 83.1%，无ciDME 4.9%，ciDME 12.0%，DME 0%不可接受。SDOCT的分级图像（N=217，96.4%）显示75.6%没有DME，9.8%没有ciDME，11.1%有ciDME。图像的不可分级率（黄斑＞50%的可视化较差）为AU:0.9%，SS:4.4%和RV:6.2%。对于DME，不同设备的敏感性和特异性相似（0.5-0.64，0.93-0.97）。对于所有设备的非糖尿病性黄斑病变（ERM、色素上皮脱离、牵引性视网膜脱离），敏感性为低至中等（0.2-0.5），但具有高度特异性（0.93-1.00）。结论：与SDOCT相比，手持黄斑成像在识别黄斑病变方面具有高特异性但低灵敏度。这表明SDOCT评估对眼底摄影中怀疑患有DME的患者的重要性，从而导致更适当的转诊细化。

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来源期刊

Ophthalmic Research 医学-眼科学

CiteScore

3.80

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Ophthalmic Research'' features original papers and reviews reporting on translational and clinical studies. Authors from throughout the world cover research topics on every field in connection with physical, physiologic, pharmacological, biochemical and molecular biological aspects of ophthalmology. This journal also aims to provide a record of international clinical research for both researchers and clinicians in ophthalmology. Finally, the transfer of information from fundamental research to clinical research and clinical practice is particularly welcome.