Chow Sing-Pey, Aiello Lloyd M, Cavallerano Jerry D, Katalinic Paula, Hock Kristen, Tolson Ann, Kirby Rita, Bursell Sven-Erik, Aiello Lloyd Paul
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.
Ophthalmology. 2006 May;113(5):833-40. doi: 10.1016/j.ophtha.2005.12.025.
To evaluate the ability of stereoscopic nonmydriatic digital retinal imaging to detect ocular pathologic features other than diabetic retinopathy (DR) in patients with diabetes mellitus (DM) compared with dilated retinal examination by retinal specialist ophthalmologists.
Clinic-based comparative instrument study and retrospective chart review.
Two hundred eighty Joslin Diabetes Center outpatients (560 eyes) with type 1 or type 2 DM.
Nonsimultaneous stereoscopic nonmydriatic digital retinal images (640 x 480 pixels) of three 45 degrees retinal fields were acquired and graded for clinical level of DR and other ocular pathologic features by certified readers according to Joslin Vision Network (JVN) protocol. Retrospective chart review compared findings from JVN digital images with findings from dilated retinal examination by retinal specialists performed within an average of 39.6 days of digital imaging. An independent senior retinal specialist adjudicated disagreements by review of 7 standard field 35-mm Early Treatment Diabetic Retinopathy Study protocol fundus photographs and JVN images.
Detection of non-DR ocular pathologic features by digital imaging as compared with clinical examination.
Nonmydriatic digital evaluation identified at least 1 non-DR ocular finding in 40.7% of patients (114/280). Non-diabetes mellitus ocular pathologic features identified by digital images, clinical examination, or both included cataract (n = 100); age-related maculopathy (n = 52); suspicion of glaucoma (n = 18); choroidal lesions (n = 18); evidence of systemic disorder (e.g., hypertension or renal disease; n = 15); epiretinal membrane (n = 11); chorioretinal atrophy, scar, or both (n = 6); retinal emboli (n = 3); retinitis pigmentosa (n = 1); and asteroid hyalosis (n = 1). Agreement of nonmydriatic imaging with clinical examination for presence and absence of these findings was 95.4%, 91.3%, 98.2%, 98.6%, 98.2%, 99.6%, 100%, 100%, 100%, and 100%, respectively. Kappa values for all non-DR lesions demonstrated near perfect agreement (kappa> or =0.80) except for age-related maculopathy (kappa = 0.71) and choroidal lesions (kappa = 0.73), where agreement was substantial. Overall, only 55 eyes (9.8%) were ungradable for level of DR and 85 eyes (15.2%) were ungradable for macular edema.
Joslin Vision Network nonmydriatic digital imaging demonstrated excellent agreement with dilated ophthalmic examination by retinal specialists in the detection of ocular disease other than DR, suggesting a potential role for this technology in evaluating non-DR disorders and highlighting the extent of findings other than retinopathy in patients with diabetes.
与视网膜专科眼科医生进行的散瞳视网膜检查相比，评估立体非散瞳数字视网膜成像检测糖尿病患者除糖尿病视网膜病变（DR）之外眼部病理特征的能力。
基于临床的比较器械研究及回顾性病历审查。
280例1型或2型糖尿病的乔斯林糖尿病中心门诊患者（560只眼）。
获取三个45度视网膜区域的非同步立体非散瞳数字视网膜图像（640×480像素），并由经过认证的阅片者根据乔斯林视觉网络（JVN）方案对DR的临床级别及其他眼部病理特征进行分级。回顾性病历审查将JVN数字图像的检查结果与视网膜专科医生在数字成像平均39.6天内进行的散瞳视网膜检查结果进行比较。一位独立的资深视网膜专科医生通过审查7张标准视野35毫米早期糖尿病性视网膜病变研究方案眼底照片和JVN图像来裁决分歧。
与临床检查相比，通过数字成像检测非DR眼部病理特征。
非散瞳数字评估在40.7%的患者（114/280）中发现至少1项非DR眼部病变。通过数字图像、临床检查或两者发现的非糖尿病性眼部病理特征包括白内障（n = 100）；年龄相关性黄斑病变（n = 52）；疑似青光眼（n = 18）；脉络膜病变（n = 18）；全身性疾病证据（如高血压或肾病；n = 15）；视网膜前膜（n = 11）；脉络膜视网膜萎缩、瘢痕或两者皆有（n = 6）；视网膜栓子（n = 3）；色素性视网膜炎（n = 1）；以及星状玻璃体病变（n = 1）。这些病变的有无在非散瞳成像与临床检查之间的一致性分别为95.4%、91.3%、98.2%、98.6%、98.2%、99.6%、100%、100%、100%和100%。除年龄相关性黄斑病变（kappa = 0.71）和脉络膜病变（kappa = 0.73）一致性为实质性外，所有非DR病变的kappa值均显示出近乎完美的一致性（kappa≥0.80）。总体而言，仅55只眼（9.8%）因DR级别无法分级，85只眼（15.2%）因黄斑水肿无法分级。
乔斯林视觉网络非散瞳数字成像在检测除DR之外的眼部疾病方面与视网膜专科医生的散瞳眼科检查显示出极佳的一致性，表明该技术在评估非DR疾病方面具有潜在作用，并突出了糖尿病患者中除视网膜病变之外的病变范围。
