Corresponding author: Paolo S. Silva,
Diabetes Care. 2014;37(1):50-5. doi: 10.2337/dc13-1292. Epub 2013 Aug 12.
OBJECTIVE To compare efficiency of nonmydriatic ultrawide field retinal imaging (UWFI) and nonmydriatic fundus photography (NMFP) in a diabetic retinopathy (DR) ocular telehealth program. RESEARCH DESIGN AND METHODS Patients in this retrospective, comparative cohort study underwent NMFP and UWFI between 1 November 2011 and 1 November 2012. Images were evaluated for DR and diabetic macular edema (DME) by certified graders using a standard protocol at a centralized reading center. Identification of DR, image evaluation time, and rate of ungradable eyes were compared. RESULTS NMFP and UWFI were performed in 1,633 and 2,170 consecutive patients, respectively. No statistically significant differences were found between groups regarding age, diabetes duration, sex, ethnicity, or insulin use. The ungradable rate per patient for DR (2.9 vs. 9.9%, P < 0.0001) and DME (3.8 vs. 8.8%, P < 0.0001) was lower with UWFI than with NMFP. With UWFI, the median image evaluation time per patient was reduced from 12.8 to 9.2 min (P < 0.0001). The identification of patients with DR (38.4 vs. 33.8%) and vision-threatening DR (14.5 vs. 11.9%) was increased with UWFI versus NMFP. In a consecutive subgroup of 502 eyes of 301 patients with DR, the distribution of peripheral retinal lesions outside Early Treatment Diabetic Retinopathy Study fields suggested a more severe DR level in 9.0% (45 eyes). CONCLUSIONS In a standardized DR ocular telehealth program, nonmydriatic UWFI reduced the ungradable rate by 71% (to <3%) and reduced image evaluation time by 28%. DR was identified 17% more frequently after UWFI, and DR peripheral lesions suggested a more severe DR level in 9%. These data suggest that UWFI may improve efficiency of ocular telehealth programs evaluating DR and DME.
比较无散瞳超广角视网膜成像（UWFI）和非散瞳眼底照相术（NMFP）在糖尿病视网膜病变（DR）眼部远程医疗计划中的效率。
本回顾性对比队列研究的患者于 2011 年 11 月 1 日至 2012 年 11 月 1 日期间接受 NMFP 和 UWFI。图像由认证分级器使用标准方案进行 DR 和糖尿病性黄斑水肿（DME）评估，并在集中阅读中心进行。比较了 DR 的识别率、图像评估时间和不可分级眼的比例。
分别对 1633 例和 2170 例连续患者进行 NMFP 和 UWFI。两组患者在年龄、糖尿病病程、性别、种族或胰岛素使用方面无统计学差异。DR（2.9% vs. 9.9%，P < 0.0001）和 DME（3.8% vs. 8.8%，P < 0.0001）的不可分级眼率，UWFI 组均低于 NMFP 组。使用 UWFI 后，每位患者的中位图像评估时间从 12.8 分钟减少到 9.2 分钟（P < 0.0001）。与 NMFP 相比，UWFI 可增加 DR（38.4% vs. 33.8%）和威胁视力的 DR（14.5% vs. 11.9%）的识别率。在 DR 患者 301 例中 502 只眼的连续亚组中，周边视网膜病变在早期糖尿病视网膜病变研究视野之外的分布提示 9.0%（45 只眼）存在更严重的 DR 水平。
在标准化的 DR 眼部远程医疗计划中，非散瞳 UWFI 将不可分级眼率降低了 71%（<3%），并将图像评估时间缩短了 28%。UWFI 后 DR 的识别率增加了 17%，9%的 DR 周边病变提示更严重的 DR 水平。这些数据表明 UWFI 可能提高评估 DR 和 DME 的眼部远程医疗计划的效率。
