PURPOSE: To evaluate mydriatic, non-stereo digital color fundus photographs a s a screening tool for identifying and classifying exudative age-related macula r degeneration (AMD). DESIGN: Prospective case series. METH...PURPOSE: To evaluate mydriatic, non-stereo digital color fundus photographs a s a screening tool for identifying and classifying exudative age-related macula r degeneration (AMD). DESIGN: Prospective case series. METHODS: Digital color fu ndus photographs were obtained from patients seen in the AMD screening clinic ov er a 9-month period at the Ivey Eye Institute in London, Ontario. Photographs f or eligible patients were separated by eye, cataloged, blinded, and randomly lab eled before interpretation by an experienced vitreoretinal surgeon. Exact agreem ent, sensitivity, specificity, positive predictive value, and negative predictiv e value of the fundus photographs in diagnosing, classifying, and managing cases of suspected exudative AMD were then calculated against gold standard clinical examination and fluorescein angiography. RESULTS: A total of 223 imag es were used from 118 eligible patients. Exact agreement between photographic ev aluation and gold standard ranged from 89.2%(presence of pigment epithelial det achment (PED)) to 82.5%(evidence of retinal pigment epithelium geographic atrop hy). Sensitivities ranged from 89.2%(presence of choroidal neovascular membrane (CNVM)) to 40.0%(presence of PED). Specificities ranged from 94.1%(presence o f PED) to 86.8%(presence of retinal pigment epithelium geographic atrophy). Pos itive predictive value ranged from 86.1%(presence of CNVM) to 40.0%(presence o f PED). Negative predictive value ranged from 94.1%(presence of PED) to 88.9%( presence of CNVM). As a screening tool for high-risk dry changes and active exu dative changes, overall sensitivity specificity, positive predictive value, and negative predictive value were 82.1%, 79.1%, 70.4%, and 88.0%, respectively. CONCLUSIONS: Digital, non-stereo color fundus photographs are highly sensitive and have high negative predictive value as a screening tool. Very few treatable lesions are missed using telemedicine in age-related macular degeneration.展开更多
文摘PURPOSE: To evaluate mydriatic, non-stereo digital color fundus photographs a s a screening tool for identifying and classifying exudative age-related macula r degeneration (AMD). DESIGN: Prospective case series. METHODS: Digital color fu ndus photographs were obtained from patients seen in the AMD screening clinic ov er a 9-month period at the Ivey Eye Institute in London, Ontario. Photographs f or eligible patients were separated by eye, cataloged, blinded, and randomly lab eled before interpretation by an experienced vitreoretinal surgeon. Exact agreem ent, sensitivity, specificity, positive predictive value, and negative predictiv e value of the fundus photographs in diagnosing, classifying, and managing cases of suspected exudative AMD were then calculated against gold standard clinical examination and fluorescein angiography. RESULTS: A total of 223 imag es were used from 118 eligible patients. Exact agreement between photographic ev aluation and gold standard ranged from 89.2%(presence of pigment epithelial det achment (PED)) to 82.5%(evidence of retinal pigment epithelium geographic atrop hy). Sensitivities ranged from 89.2%(presence of choroidal neovascular membrane (CNVM)) to 40.0%(presence of PED). Specificities ranged from 94.1%(presence o f PED) to 86.8%(presence of retinal pigment epithelium geographic atrophy). Pos itive predictive value ranged from 86.1%(presence of CNVM) to 40.0%(presence o f PED). Negative predictive value ranged from 94.1%(presence of PED) to 88.9%( presence of CNVM). As a screening tool for high-risk dry changes and active exu dative changes, overall sensitivity specificity, positive predictive value, and negative predictive value were 82.1%, 79.1%, 70.4%, and 88.0%, respectively. CONCLUSIONS: Digital, non-stereo color fundus photographs are highly sensitive and have high negative predictive value as a screening tool. Very few treatable lesions are missed using telemedicine in age-related macular degeneration.
