Vujosevic Stela, Benetti Elisa, Massignan Francesca, Pilotto Elisabetta, Varano Monica, Cavarzeran Fabiano, Avogaro Angelo, Midena Edoardo
Fondazione G.B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientificio), Roma, Italy.
Am J Ophthalmol. 2009 Jul;148(1):111-8. doi: 10.1016/j.ajo.2009.02.031. Epub 2009 May 5.
To evaluate if simple- or multiple-field digital color nonmydriatic (NM) retinal images can replace 7 standard stereoscopic fundus photographs in the screening of diabetic retinopathy (DR).
Prospective, masked, comparative case series.
One hundred and eight eyes of 55 diabetics were studied to determine single lesions and to grade clinical levels of DR and diabetic macular edema (DME) using both 1 and 3 NM digital color retinal images compared with the Early Treatment Diabetic Retinopathy Study (ETDRS) 7 standard 35-mm stereoscopic color fundus photographs (7F-ETDRS). All eyes underwent NM 45-degree field images of 1 central field (1F-NM), NM 45-degree field images of 3 fields (3F-NM), and, after pupil dilatation, 30-degree 7F-ETDRS photography. Images were analyzed by 2 independent, masked retinal specialists (S.V. and E.B.), lesion-by-lesion according to the ETDRS protocol and for clinical severity level of DR and DME according to the international classification of DR.
Using 7F-ETDRS as the gold standard, agreement was substantial for grading clinical levels of DR and DME (kappa = 0.69 and kappa = 0.75) vs 3F-NM; moderate for DR level (kappa = 0.56) and substantial for DME (kappa = 0.66) vs 1F-NM; almost perfect for detecting presence or absence of DR (kappa = 0.88) vs both 1F-NM and 3F-NM; and almost perfect for presence or absence of DME (kappa = 0.97) vs 3F-NM and substantial (kappa = 0.75) vs 1F-NM. Sensitivity and specificity for detecting referable levels of DR were 82% and 92%, respectively, for 3F-NM and 71% and 96%, respectively, for 1F-NM.
Three color 45-degree NM fundus fields may be an effective tool in a screening setting to determine critical levels of DR and DME for prompt specialist referral. One central 45-degree image is sufficient to determine absence or presence of DR and DME, but not for grading it.
评估单视野或多视野数字彩色免散瞳（NM）视网膜图像能否在糖尿病视网膜病变（DR）筛查中替代7张标准立体眼底照片。
前瞻性、盲法、对比病例系列研究。
对55例糖尿病患者的108只眼进行研究，使用1张和3张NM数字彩色视网膜图像与早期糖尿病视网膜病变研究（ETDRS）的7张标准35毫米立体彩色眼底照片（7F - ETDRS）相比较，以确定单个病变并对DR和糖尿病性黄斑水肿（DME）的临床分级水平进行评估。所有眼睛均接受了1个中央视野的NM 45度视野图像（1F - NM）、3个视野的NM 45度视野图像（3F - NM），以及瞳孔散大后30度的7F - ETDRS摄影。图像由2名独立的、盲法的视网膜专科医生（S.V.和E.B.）根据ETDRS方案逐病变进行分析，并根据DR的国际分级标准对DR和DME的临床严重程度进行分级。
以7F - ETDRS作为金标准，与3F - NM相比，在DR和DME临床分级水平上的一致性为实质性（kappa = 0.69和kappa = 0.75）；与1F - NM相比，DR分级水平的一致性为中等（kappa = 0.56），DME的一致性为实质性（kappa = 0.66）；与1F - NM和3F - NM相比，检测DR有无的一致性几乎完美（kappa = 0.88）；与3F - NM相比，检测DME有无的一致性几乎完美（kappa = 0.97），与1F - NM相比为实质性（kappa = 0.75）。检测可转诊DR水平的敏感性和特异性，3F - NM分别为82%和92%，1F - NM分别为71%和96%。
三张45度彩色NM眼底视野图像可能是筛查中确定DR和DME关键水平以便及时转诊至专科医生的有效工具。一张中央45度图像足以确定DR和DME的有无，但不足以对其进行分级。
