Massin P, Erginay A, Ben Mehidi A, Vicaut E, Quentel G, Victor Z, Marre M, Guillausseau P J, Gaudric A
Department of Ophthalmology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France.
Diabet Med. 2003 Aug;20(8):635-41. doi: 10.1046/j.1464-5491.2003.01002.x.
To compare the results of fundus photography using a new non-mydriatic digital camera with the results of reference standard of Early Treatment Diabetic Retinopathy Study (ETDRS) retinal photographs, for the detection of diabetic retinopathy (DR).
Fundus colour photographs were taken with a Topcon non-mydriatic camera of 147 eyes of 74 diabetic patients, without pupillary dilation (five overlapping fields of 45 degrees; posterior pole, nasal, temporal, superior and inferior). Three retinal specialists classified the photographs in a masked fashion, as showing no DR or mild non-proliferative DR (NPDR) not requiring referral, moderate or more severe NPDR and/or macular oedema, or as non-gradable image requiring referral. ETDRS 35-mm colour slides served as reference images for DR detection.
For moderately severe to severe DR, the sensitivities of detection reported by the three observers were 92, 100 and 92%, respectively, and the specificities, 87, 85, and 88%. For four levels of DR severity (none or mild NPDR, moderate NPDR, severe NPDR and proliferative DR), the percentages of exact agreement between the three observers on the retinopathy grades assigned to the non-mydriatic photographs and to the ETDRS reference slides were 94.6, 93 and 87.6%, respectively (kappa 0.60-0.80). Sixteen eyes of nine patients (11%) were judged ungradable by at least one observer. In a second series of 110 patients, evaluated in the setting of a screening procedure, fewer photographs were ungradable (< 6%).
These results suggest that fundus photographs taken by the Topcon TRC-NW6S non-mydriatic camera, without pupillary dilation, are suitable for DR screening.
比较使用新型免散瞳数码相机进行眼底摄影的结果与早期糖尿病视网膜病变研究（ETDRS）视网膜照片这一参考标准的结果，以检测糖尿病视网膜病变（DR）。
使用拓普康免散瞳相机对74例糖尿病患者的147只眼睛进行眼底彩色摄影，无需散瞳（45度的五个重叠视野；后极部、鼻侧、颞侧、上方和下方）。三位视网膜专家以盲法对照片进行分类，分为无DR或无需转诊的轻度非增殖性DR（NPDR）、中度或更严重的NPDR和/或黄斑水肿，或为需要转诊的不可分级图像。ETDRS 35毫米彩色幻灯片用作DR检测的参考图像。
对于中度至重度DR，三位观察者报告的检测灵敏度分别为92%、100%和92%，特异性分别为87%、85%和88%。对于DR严重程度的四个级别（无或轻度NPDR、中度NPDR、重度NPDR和增殖性DR），三位观察者对免散瞳照片和ETDRS参考幻灯片所分配的视网膜病变等级的完全一致率分别为94.6%、93%和87.6%（kappa值为0.60 - 0.80）。至少一位观察者判定9例患者的16只眼睛（11%）不可分级。在第二项针对110例患者的系列研究中，在筛查程序中进行评估时，可以分级的照片较少（<6%）。
这些结果表明，使用拓普康TRC - NW6S免散瞳相机在无需散瞳的情况下拍摄的眼底照片适用于DR筛查。
