Wang Yu T, Tadarati Mongkol, Wolfson Yulia, Bressler Susan B, Bressler Neil M
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Retina Division, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand3Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Ophthalmol. 2016 Feb;134(2):222-8. doi: 10.1001/jamaophthalmol.2015.5332.
Diagnosing diabetic macular edema (DME) from monocular fundus photography vs optical coherence tomography (OCT) central subfield thickness (CST) can yield different prevalence rates for DME. Epidemiologic studies and telemedicine screening typically use monocular fundus photography, while treatment of DME uses OCT CST.
To compare DME prevalence from monocular fundus photography and OCT.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of DME grading based on monocular fundus photographs and OCT images obtained from patients with diabetic retinopathy at a single visit between July 1, 2011, and June 30, 2014, at a university-based practice and analyzed between July 30, 2014, and May 29, 2015. Presence of DME, including clinically significant macular edema (CSME), on monocular fundus photographs used definitions from the Multi-Ethnic Study of Atherosclerosis (MESA) and the National Health and Nutrition Examination Survey (NHANES). Presence of DME on OCT used Diabetic Retinopathy Clinical Research Network eligibility criteria thresholds of CST for trials evaluating anti-vascular endothelial growth factor treatments.
Prevalence of DME based on monocular fundus photographs or OCT.
A total of 246 eyes of 158 participants (mean [SD] age, 65.0 [11.9] years; 48.7% women; 60.8% white) were included. Among the 246 eyes, the prevalences of DME (61.4%) and CSME (48.5%) based on MESA definitions for monocular fundus photographs were greater than the DME prevalence based on OCT (21.1%) by 40.2% (95% CI, 32.8%-47.7%; P < .001) and 27.2% (95% CI, 19.2%-35.3%; P < .001), respectively. Using NHANES definitions, DME and CSME prevalences from monocular fundus photographs (28.5% and 21.0%, respectively) approximated the DME prevalence from OCT (21.1%). However, among eyes without DME on OCT, 58.2% (95% CI, 51.0%-65.3%) and 18.0% (95% CI, 12.9%-24.2%) were diagnosed as having DME on monocular fundus photographs using MESA and NHANES definitions, respectively, including 47.0% (95% CI, 39.7%-54.5%) and 10.3% (95% CI, 6.3%-15.7%), respectively, with CSME. Among eyes with DME on OCT, 26.9% (95% CI, 15.6%-41.0%) and 32.7% (95% CI, 20.3%-47.1%) were not diagnosed as having either DME or CSME on monocular fundus photographs using MESA and NHANES definitions, respectively.
These data suggest that many eyes diagnosed as having DME or CSME on monocular fundus photographs have no DME based on OCT CST, while many eyes diagnosed as not having DME or CSME on monocular fundus photographs have DME on OCT. While limited to 1 clinical practice, caution is suggested when extrapolating prevalence of eyes that may benefit from anti-vascular endothelial growth factor therapy based on epidemiologic surveys using photographs to diagnose DME.
通过单眼眼底摄影与光学相干断层扫描（OCT）中心子野厚度（CST）来诊断糖尿病性黄斑水肿（DME），可能会得出不同的DME患病率。流行病学研究和远程医疗筛查通常使用单眼眼底摄影，而DME的治疗则使用OCT CST。
比较单眼眼底摄影和OCT得出的DME患病率。
设计、设置和参与者：一项回顾性横断面研究，基于2011年7月1日至2014年6月30日期间在一家大学诊所单次就诊的糖尿病视网膜病变患者的单眼眼底照片和OCT图像进行DME分级，并于2014年7月30日至2015年5月29日进行分析。单眼眼底照片上DME的存在，包括临床上显著的黄斑水肿（CSME），采用动脉粥样硬化多民族研究（MESA）和国家健康与营养检查调查（NHANES）的定义。OCT上DME的存在采用糖尿病视网膜病变临床研究网络在评估抗血管内皮生长因子治疗的试验中使用的CST资格标准阈值。
基于单眼眼底照片或OCT的DME患病率。
共纳入158名参与者的246只眼（平均[标准差]年龄，65.0[11.9]岁；48.7%为女性；60.8%为白人）。在这246只眼中，基于MESA定义的单眼眼底照片的DME患病率（61.4%）和CSME患病率（48.5%）分别比基于OCT的DME患病率（21.1%）高40.2%（95%CI，32.8%-47.7%；P＜0.001）和27.2%（95%CI，19.2%-35.3%；P＜0.001）。使用NHANES定义，单眼眼底照片的DME和CSME患病率（分别为28.5%和21.0%）接近OCT的DME患病率（21.1%）。然而，在OCT上无DME的眼中，分别使用MESA和NHANES定义，单眼眼底照片诊断为有DME的比例为58.2%（95%CI，51.0%-65.3%）和18.0%（95%CI，12.9%-24.2%），其中分别有47.0%（95%CI，39.7%-54.5%）和10.3%（95%CI，6.3%-15.7%）为CSME。在OCT上有DME的眼中，分别使用MESA和NHANES定义，单眼眼底照片未诊断为有DME或CSME的比例为26.9%（95%CI，15.6%-41.0%）和32.7%（95%CI，20.3%-47.1%）。
这些数据表明，许多在单眼眼底照片上被诊断为有DME或CSME的眼，基于OCT CST并无DME，而许多在单眼眼底照片上被诊断为无DME或CSME的眼，在OCT上有DME。虽然该研究仅限于1个临床机构，但在根据使用照片诊断DME的流行病学调查推断可能从抗血管内皮生长因子治疗中获益的眼的患病率时，建议谨慎。
