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. 2014 Aug;62(8):851-6.
doi: 10.4103/0301-4738.141039.

Sensitivity and specificity of nonmydriatic digital imaging in screening diabetic retinopathy in Indian eyes

Vishali Gupta  1 , Reema Bansal, Amod Gupta, Anil Bhansali
Affiliations

Sensitivity and specificity of nonmydriatic digital imaging in screening diabetic retinopathy in Indian eyes

Vishali Gupta et al. Indian J Ophthalmol. 2014 Aug.

Abstract

Background: Nonmydriatic digital imaging (NMDI) is ideal for screening diabetic retinopathy (DR), but its use in Indian eyes has not been evaluated.

Aim: The aim was to evaluate the sensitivity and specificity of NMDI as a screening tool in detecting DR in Indian eyes.

Design: A prospective, nonrandomized, noncomparative, noninterventional study.

Materials and methods: A total of 500 diabetic patients visiting the endocrinology clinic (September 2008-June 2010) underwent NMDI (Zeiss Procam), followed by routine dilated fundus photography (FP; Zeiss Visupac 450+) of 345° retinal fields (1) optic disc and macula, (2) superotemporal, and (3) nasal to optic disc. Two-masked retina specialists graded the images for quality and severity of DR, and compared between NMDI and dilated FP.

Statistical analysis: SPSS Windows 17 for version.

Results: Mean age was 52.97 ± 13.46 years (306 males: 194 females). The rate of ungradable images was 30.6% and 31% by the two observers. By observer 1, the sensitivity and specificity of detecting any DR was 58.8% and 69.1%, respectively, (κ = 0.608) and sight-threatening DR (STDR) was 63.1% and 68.9%, respectively, (κ = 0.641). By observer 2, the sensitivity and specificity was 57.3% and 68.3%, respectively, for any DR (κ = 0.593) and 62.8% and 68.3%, respectively, for STDR (κ = 0.637). The level of agreement between two observers was high (κ = 0.96).

Conclusion: A high rate of poor quality photographs and low sensitivity limited the use of NMDI as a perfect screening system, particularly in dark iris population with diabetes as seen in Indian eyes.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Anterior segment photographs of the right (a) and left (b) eyes of a 57-year-old male showing undilated pupils just before obtaining nonmydriatic retinal imaging (NMRI). The NMRI showed grade 4 quality photographs in both right (c) and left (d) eyes. Both eyes were ungradable for detection of diabetic retinopathy (DR). Dilated fundus photographs of right (e) and left (f) eyes of same patient as in a-d, showing grade 1 quality images and absence of any DR
Figure 2
Figure 2
Anterior segment photographs of the right (a) and left (b) eyes of a 41-year-old male showing undilated pupils just before obtaining NMRI. The NMRI showed grade 5 quality photographs in both right (c) and left (d) eyes. Both eyes were ungradable for detection of diabetic retinopathy. Dilated fundus photographs (e and f) and fluorescein angiography photographs (g and h) of same patient as in a-d, showing grade 1 quality images. There is presence of clinically significant macular edema and neovascularization elsewhere on the retina in both eyes, suggestive of proliferative diabetic retinopathy
See this image and copyright information in PMC

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