Nonmydriatic ultrawide field retinal imaging system and nonmydriatic two-field digital fundus photography system in a large-scale diabetic retinopathy screening_Chinese Journal of Ocular Fundus Diseases

Authors：

LiZhanfeng ¹ , LiZhiqing ¹ , LiuJuping ¹ , PeiJinyun ² , YuRongguo ¹ , HuLiying ¹ , GuoJunlin ¹ , ChenZhenna ¹ , MuYajun ¹ ,  LiXiaorong ¹

1. Tianjin Medical University Hospital, Tianjin Medical University Eye Institute, School of Optometry and Ophthalmology, Tianjin Medical University, Tianjin 300384, China;
2. Department of Ophtalmology, Santan Hospital in Nankai District of Tianjin, Tianjin 300193, China;

Corresponding author：

LiXiaorong, Email: xiaorli@163.com

Keywords：

Diabetic retinopathy/diagnosis; Fluorescein angiography

DOI：

10.3760/cma.j.issn.1005-1015.2016.03.004

Video：

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Objective To compare the consistency and difference of nonmydriatic ultrawide field retinal imaging system versus nonmydriatic 2-field 45°digital fundus photography system in a large-scale diabetic retinopathy (DR) screening. Methods A total of 733 with type 2 diabetic patients (1466 eyes) underwent nonmydriatic ultrawide field retinal imaging and nonmydriatic 2-field 45°digital fundus photography examination. Two independent readers graded images respectively to determine the stage of DR. A third masked retinal specialist adjudicated discrepancies. Using nonmydriatic 2-field 45°digital fundus photography examination as the standard, the consistency of nonmydriatic ultrawide field retinal imaging was evaluated. The statistic index included sensitivity, specificity, Youden index and Kappa value. The difference of two methods was analyzed by comparative t-test. Results Based on nonmydriatic ultrawide field retinal imaging, the results were as follows: non DR (NDR) in 1062 eyes (74.1%), DR in 340 eyes (23.7%), ungradable in 32 eyes (2.2%). Among 340 DR eyes, there were mild nonproliferative DR (NPDR) in 48 eyes, moderate NPDR in 216 eyes, severe NPDR in 57 eyes, proliferative DR (PDR) in 19 eyes. Based on nonmydriatic 2-field 45°digital fundus photography, the results were as follows: NDR in 1080 eyes (75.3%), DR in 270 eyes (18.8%), ungradable in 84 eyes (5.6%). Among 270 DR eyes, there were NPDR in 36 eyes, moderate NPDR in 175 eyes, severe NPDR in 53 eyes, PDR in 6 eyes. Compared with nonmydriatic 2-field 45°digital fundus photography for screening DR, the sensitivity was 98.0%, the specificity was 95.0%, and the kappa value was 0.87. For screening severe NPDR and PDR, the sensitivity was 100.0%, the specificity was 99.0%, and the kappa value was 0.94. The DR detection rate and the ratio of the picture can't interpretation between two methods both had significant difference (P=0.00). Conclusions In rapid large-scale DR screening, there is high consistency between nonmydriatic ultrawide field retinal imaging versus nonmydriatic 2-field 45°digital fundus photography. Nonmydriatic ultrawide field retinal imaging is proved to be more adaptive, and more comprehensive and precise.

Citation： LiZhanfeng, LiZhiqing, LiuJuping, PeiJinyun, YuRongguo, HuLiying, GuoJunlin, ChenZhenna, MuYajun, LiXiaorong. Nonmydriatic ultrawide field retinal imaging system and nonmydriatic two-field digital fundus photography system in a large-scale diabetic retinopathy screening. Chinese Journal of Ocular Fundus Diseases, 2016, 32(3): 243-247. doi: 10.3760/cma.j.issn.1005-1015.2016.03.004 Copy

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10.	Kernt M, Pinter F, Hadi I, et al.Diabetic retinopathy:comparison of the diagnostic features of ultra-widefield scanning laser ophthalmoscopy Optomap with EDTRS 7-field fundus photography[J].Ophthalmologe, 2011, 108(2):117-123.DOI:10.1007/s00347-010-2226-4.
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1. Wong TY, Klein R, Islam FM, et al.Diabetic retinopathy in a multi-ethnic cohort in the United States[J].Am J Ophthalmol, 2006, 141(3):446-455.
2. 张蕾, 许维强, 谭荣强, 等.糖尿病视网膜病变筛查方式探讨[J].国际眼科杂志, 2010, 10(3):482-484.DOI:10.3969/j.issn.1672-5123.2010.03.026.Zhang L, Xu WQ, Tan RQ, et al.Study of diabetic retinopathy screening modes[J].Int Eye Sci, 2010, 10(3):482-484.DOI:10.3969/j.issn.1672-5123.2010.03.026.
3. 康立华, 杨金奎, 王光璐, 等.单视野免散瞳数码眼底照相筛查糖尿病视网膜病变敏感性和特异性[J].医学研究杂志, 2007, 36(7):25-28.DOI:10.3969/j.issn.1673-548X.2007.07.010.Kang LH, Yang JK, Wang GL, et al.The sensitivity and specificity of one-field, non-mydriatic, 45° digital photography for diabetic retinopathy screening[J].J Med Res, 2007, 36(7):25-28.DOI:10.3969/j.issn.1673-548X.2007.07.010.
4. 李毅斌, 张丽丽, 石敬, 等.糖尿病视网膜病变的数码眼底照相筛查方法评价[J].眼科, 2008, 17(5):331-334.Li YB, Zhang LL, Shi J, et al.An evaluation on screening of diabetic retinopathy with digital fundus photography[J].Ophthalmol CHN, 2008, 17(5):331-334.
5. Silva PS, Cavallerano JD, Sun JK, et al.Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy[J]. Am J Ophthalmol, 2012, 154(3):549-559.DOI:10.1016/j.ajo.2012.03.019.
6. Kernt M, Hadi I, Pinter F, et al.Assessment of diabetic retinopathy using nonmydriatic ultra-widefield scanning laser ophthalmoscopy (Optomap) compared with ETDRS 7-field stereo photography[J].Diabetes Care, 2012, 35(12):2459-2463.DOI:10.2337/dc12-0346.
7. Robert MJP, Shahrnaz I, Ankur G, et al.Comparison of Optomap ultrawide-field imaging versus slit-lamp biomicroscopy for assessment of diabetic retinopathy in a real-life clinic[J].Clin Ophthalmol, 2014, 29(8):1413-1417.DOI:10.2147/OPTH.S66700.eCollection2014.
8. Neubauer AS, Kernt M, Haritoglou C, et al.Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy(Optomap)[J]. Graefe's Arch Clin Exp Ophthalmol, 2008, 246(2):229-235.
9. Khandhadia S, Madhusudhana KC, Kostakou A, et al. Use of Optomap for retinal screening within an eye casualty setting[J].Br J Ophthalmol, 2009, 93(1):52-55.DOI:10.1136/bjo.2008.148072.
10. Kernt M, Pinter F, Hadi I, et al.Diabetic retinopathy:comparison of the diagnostic features of ultra-widefield scanning laser ophthalmoscopy Optomap with EDTRS 7-field fundus photography[J].Ophthalmologe, 2011, 108(2):117-123.DOI:10.1007/s00347-010-2226-4.
11. 赵堪兴, 杨培增, 瞿佳, 等.眼科学[M].8版.北京:人民卫生出版社, 2013:218-219.Zhao KX, Yang PZ, Qu J, et al. Ophthalmology[M].8th ed.Beijing:The People's Medical Publishing House, 2013:218-219.
12. Raffael L, Kristine L, Lala C, et al.Nonmydriatic ultra-wide-field scanning laser ophthalmoscopy(Optomap) versus two-field fundus photography in diabetic retinopathy[J].Ophthalmologica, 2014, 231(1):31-36.DOI:10.1159/000355092.
13. Brown K, Sewell JM, Trempe C, et al.Comparison of image-assisted versus traditional fundus examination[J].Eye Brain, 2013, 5(1):1-8.

Chinese Journal of Ocular Fundus Diseases

Nonmydriatic ultrawide field retinal imaging system and nonmydriatic two-field digital fundus photography system in a large-scale diabetic retinopathy screening

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