BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician reg-ularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve th...BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician reg-ularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologistwas evaluated. PATIENTS AND METHODS: In a masked prospective study, images were obtained from 111 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared. RESULTS: Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on “ no retinopathy” versus “ any retinopathy” was excellent (Kappa=0.96). Agreement based on “ microaneurysms or less retinopathy” versus “ retinal hemorrhages or worse retinopathy” was very good (Kappa=0.83). CONCLUSIONS: The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.展开更多
Aims: To assess the diagnostic accuracy of optical coherence tomography (OCT), with/without colour fundus photographs, in predicting fundus fluorescein angiogr aphy(FFA) findings in patients suspected of having choroi...Aims: To assess the diagnostic accuracy of optical coherence tomography (OCT), with/without colour fundus photographs, in predicting fundus fluorescein angiogr aphy(FFA) findings in patients suspected of having choroidal neovascularisation (CNV). Methods: A consecutive series of patients suspected of having CNV underwe nt OCT and stereo FFA images, which were assigned a diagnosis by two masked obse rvers, one examining OCT alone and then OCT plus stereo colour photographs, and one examining FFA alone. The main outcome measures were the diagnostic accuracy of OCT (with/without colour photos) in predicting the presence of CNVand secondl y the characteristics of the CNV compared to the FFA findings. Results: 131 eyes of 118 patients were analysed. The sensitivity and specificity of OCT for detec ting new potentially treatable CNV lesions compared to FFA was 96.4%, and 66.0 %, respectively. For OCT with stereo images the sensitivity was 94.0%and speci ficity 89.4%. For detecting CNV with a classic component the sensitivity and sp ecificity of OCT alone was 78.6%and 82.7%. With stereo colour images the sensi tivity was 82.1%and specificity 89.3%. Conclusion: OCT is good at detecting th e presence of CNV in patients suspected of having new CNV. However, it is less a ccurate at identifying the exact components of CNV. OCT cannot at present replac e FFA in accurately diagnosing CNV components. However, this imaging method may have a role as a screening tool to help prioritise FFA requests.展开更多
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BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician reg-ularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologistwas evaluated. PATIENTS AND METHODS: In a masked prospective study, images were obtained from 111 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared. RESULTS: Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on “ no retinopathy” versus “ any retinopathy” was excellent (Kappa=0.96). Agreement based on “ microaneurysms or less retinopathy” versus “ retinal hemorrhages or worse retinopathy” was very good (Kappa=0.83). CONCLUSIONS: The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.
文摘Aims: To assess the diagnostic accuracy of optical coherence tomography (OCT), with/without colour fundus photographs, in predicting fundus fluorescein angiogr aphy(FFA) findings in patients suspected of having choroidal neovascularisation (CNV). Methods: A consecutive series of patients suspected of having CNV underwe nt OCT and stereo FFA images, which were assigned a diagnosis by two masked obse rvers, one examining OCT alone and then OCT plus stereo colour photographs, and one examining FFA alone. The main outcome measures were the diagnostic accuracy of OCT (with/without colour photos) in predicting the presence of CNVand secondl y the characteristics of the CNV compared to the FFA findings. Results: 131 eyes of 118 patients were analysed. The sensitivity and specificity of OCT for detec ting new potentially treatable CNV lesions compared to FFA was 96.4%, and 66.0 %, respectively. For OCT with stereo images the sensitivity was 94.0%and speci ficity 89.4%. For detecting CNV with a classic component the sensitivity and sp ecificity of OCT alone was 78.6%and 82.7%. With stereo colour images the sensi tivity was 82.1%and specificity 89.3%. Conclusion: OCT is good at detecting th e presence of CNV in patients suspected of having new CNV. However, it is less a ccurate at identifying the exact components of CNV. OCT cannot at present replac e FFA in accurately diagnosing CNV components. However, this imaging method may have a role as a screening tool to help prioritise FFA requests.
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.
