Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
Acta Ophthalmol. 2023 Sep;101(6):670-678. doi: 10.1111/aos.15651. Epub 2023 Feb 27.
To compare diabetic retinopathy (DR) severity identified on handheld retinal imaging with ultrawide field (UWF) images.
Mydriatic images of 225 eyes of 118 diabetic patients were prospectively imaged with the Aurora (AU) handheld retinal camera [5-field protocol (macula-centred, disc-centred, temporal, superior, inferior)] and compared with UWF images. Images were classified based on the international classification for DR. Sensitivity, specificity, kappa statistics (K/Kw) were calculated on an eye and person-level.
Distribution of DR severity by AU/UWF images (%) by eye was no DR 41.3/36.0, mild non-proliferative DR (NPDR) 18.7/17.8, moderate 10.2/10.7, severe 16.4/15.1, proliferative DR (PDR) 13.3/20.4. Agreement between UWF and AU was exact in 64.4%, within 1-step 90.7%, k = 0.55 (95% CI:0.45-0.65), and kw = 0.79 (95% CI:0.73-0.85) by eye, and exact in 68%, within 1-step 92.9%, k = 0.58 (95% CI:0.50-0.66), and kw = 0.76 (95% CI:0.70-0.81) by person. Sensitivity/specificity for any DR, refDR, vtDR and PDR were as follows: 0.90/0.83, 0.90/0.97, 0.82/0.95 and 0.69/1.00 by person and 0.86/0.90, 0.84/0.98, 0.75/0.95 and 0.63/0.99 by eye. Handheld imaging missed 37% (17/46) eyes and 30.8% (8/26) persons with PDR. Only 3.9% (1/26) persons or 6.5% (3/46) eyes with PDR were missed if a referral threshold of moderate NPDR was used.
Data from this study show that comparing UWF and handheld images, when PDR was the referral threshold for handheld devices, 37.0% of eyes or 30.8% of patients with PDR were missed. Due to the identification of neovascular lesions outside of the handheld fields, lower referral thresholds are needed if handheld devices are used.
比较手持视网膜成像与超广角（UWF）图像识别的糖尿病视网膜病变（DR）严重程度。
前瞻性地对 118 例糖尿病患者的 225 只眼进行散瞳图像采集，使用 Aurora（AU）手持视网膜相机进行 5 个视野（黄斑中心、视盘中心、颞侧、上方、下方）的拍摄，并与 UWF 图像进行比较。根据国际 DR 分类对图像进行分类。在个体和眼部水平上计算敏感性、特异性、kappa 统计量（K/Kw）。
按眼部 DR 严重程度分布（AU/UWF 图像，%）为无 DR 41.3/36.0、轻度非增殖性 DR（NPDR）18.7/17.8、中度 10.2/10.7、重度 16.4/15.1、增殖性 DR（PDR）13.3/20.4。UWF 与 AU 的一致性在个体水平上为完全一致占 64.4%，相差 1 级占 90.7%，kappa 值为 0.55（95%CI：0.45-0.65），加权 kappa 值为 0.79（95%CI：0.73-0.85）；在眼部水平上为完全一致占 68%，相差 1 级占 92.9%，kappa 值为 0.58（95%CI：0.50-0.66），加权 kappa 值为 0.76（95%CI：0.70-0.81）。任何 DR、参考 DR、vtDR 和 PDR 的敏感性/特异性如下：个体水平为 0.90/0.83、0.90/0.97、0.82/0.95 和 0.69/1.00，眼部水平为 0.86/0.90、0.84/0.98、0.75/0.95 和 0.63/0.99。手持成像漏诊了 37%（17/46）只眼和 30.8%（8/26）名 PDR 患者。如果将中度 NPDR 作为手持设备的转诊阈值，仅漏诊了 3.9%（1/26）名患者或 6.5%（3/46）只眼的 PDR。
本研究数据表明，与 UWF 图像相比，当 PDR 为手持设备的转诊阈值时，37.0%的眼部或 30.8%的 PDR 患者被漏诊。如果使用手持设备，由于在手持视野之外发现了新生血管病变，需要降低转诊阈值。
