Joo Yong Lee, Sung Jae Yang, Soo Geun Joe, June-Gone Kim, Young Hee Yoon (Seoul, South Korea)

Advantages:

The purpose of the study was to compare the wide fundus photography taken by the Optomap P200C and 7 standard early treatment diabetic retinopathy (ETDRS) fundus photographs for diabetic retinopathy screening.

Methods:

In 25 diabetic patients (50 eyes), one 200-degree wide field fundus photography without dilation by Optomap p200C and 30-degree 7-field photography after dilation were taken in both eyes. Images were assessed by two ophthalmologists for determination of abnormal retinal findings and clinical levels of diabetic retinopathy according to the ETDRS protocol.

Effectiveness / Safety:

Using 7 standard ETDRS fundus photographs as the gold standard, agreement was substantial for grading clinical levels of diabetic retinopathy  (kappa: 0.615).  It showed that almost perfect agreement for detecting presence of new vessel, vitreous or preretinal hemorrhage, epiretinal membrane, and hard exudate (kappa: 0.888 Р1.000). However, wide fundus image showed relatively low agreement with 7 standard ETDRS fundus photography in detecting cotton wool patch, retinal hemorrhage, and microaneurysm. It was related to bad quality of wide fundus images in the peripheral field related to lid or long eyelash.

Take home message:

Wide fundus image may be an effective tool as a screening examination to determine critical levels of diabetic retinopathy. Also, wide fundus photography has advantages in rapid, non-mydriatic examination of almost the entire retina as a screening device for diabetic retinopathy.