Brown Kristen, Sewell Jeanette M, Trempe Clement, Peto Tunde, Travison Thomas G
New England College of Optometry.
New England Eye Institute, Boston, MA, USA.
Eye Brain. 2013 Feb 13;5:1-8. doi: 10.2147/EB.S37646. eCollection 2013.
The purpose of this study was to evaluate the ability of image-assisted fundus examination to detect retinal lesions compared with traditional fundus examination.
Subjects were imaged using a nonmydriatic ultrawide field scanning laser ophthalmoscope. After imaging, subjects underwent both a traditional and an image-assisted fundus examination, in random order. During the image-assisted method, ultrawide field scanning laser ophthalmoscopic images were reviewed in conjunction with a dilated fundus examination. Lesions detected by each method were assigned to one of three regions, ie, optic disc, posterior pole/macula, or mid-to-peripheral retina. Discrepancies between the image-assisted and the traditional examination methods were adjudicated by a retinal ophthalmologist.
In total, 170 subjects (339 eyes) were recruited. Agreement between image-assisted and traditional fundus examination varied by lesion type and was excellent for staphyloma (kappa 0.76), fair for suspicious cupping (kappa 0.66), drusen in the posterior pole/macula and mid-to-peripheral retina (0.45, 0.41), retinal pigment epithelial changes in the posterior pole/macula (0.54), peripheral retinal degeneration (0.50), cobblestone (0.69), vitreoretinal interface abnormalities (0.40), and vitreous lesions (0.53). Agreement was poor for hemorrhage in the mid-to-peripheral retina (kappa 0.33), and nevi in the mid-to-peripheral retina (0.34). When the methods disagreed, the results indicated a statistically significant advantage for the image-assisted examination in detecting suspicious cupping ( = 0.04), drusen in the posterior pole/macula and mid-to-peripheral retina ( = 0.004, < 0.001), retinal pigment epithelial changes in the posterior pole/macula ( = 0.04), nevi in the posterior pole/macula and mid-to-peripheral retina ( = 0.01, = 0.007), peripheral retinal degeneration ( < 0.001), hemorrhage in the mid-to-peripheral retina ( = 0.01), and vitreous lesions ( < 0.001).
Image-assisted fundus examination may enhance detection of retinal lesions compared with traditional fundus examination alone.
本研究的目的是评估与传统眼底检查相比，图像辅助眼底检查检测视网膜病变的能力。
使用免散瞳超广角扫描激光检眼镜对受试者进行成像。成像后，受试者按随机顺序接受传统眼底检查和图像辅助眼底检查。在图像辅助检查方法中，结合散瞳眼底检查对超广角扫描激光检眼镜图像进行评估。每种方法检测到的病变被分配到三个区域之一，即视盘、后极/黄斑或中周部视网膜。图像辅助检查方法与传统检查方法之间的差异由视网膜眼科医生判定。
共招募了170名受试者（339只眼）。图像辅助眼底检查与传统眼底检查之间的一致性因病变类型而异，葡萄肿的一致性极佳（kappa值为0.76），可疑视杯凹陷的一致性为中等（kappa值为0.66），后极/黄斑和中周部视网膜的玻璃膜疣一致性为一般（分别为0.45、0.41），后极/黄斑的视网膜色素上皮改变一致性为中等（0.54），周边视网膜变性一致性为中等（0.50），铺路石样改变一致性为良好（0.69），玻璃体视网膜界面异常一致性为一般（0.40），玻璃体病变一致性为中等（0.53）。中周部视网膜出血（kappa值为0.33）和中周部视网膜痣（0.34）的一致性较差。当两种方法结果不一致时，结果表明图像辅助检查在检测可疑视杯凹陷（P = 0.04）、后极/黄斑和中周部视网膜的玻璃膜疣（P = 0.004，P < 0.001）、后极/黄斑的视网膜色素上皮改变（P = 0.04）、后极/黄斑和中周部视网膜的痣（P = 0.01，P = 0.007）、周边视网膜变性（P < 0.001）、中周部视网膜出血（P = 0.01）和玻璃体病变（P < 0.001）方面具有统计学显著优势。
与单独的传统眼底检查相比，图像辅助眼底检查可能会提高视网膜病变的检测率。
