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. 2023 Nov 1;43(11):1928-1935.
doi: 10.1097/IAE.0000000000003883.

INTEGRATING MACULAR OPTICAL COHERENCE TOMOGRAPHY WITH ULTRAWIDE-FIELD IMAGING IN A DIABETIC RETINOPATHY TELEMEDICINE PROGRAM USING A SINGLE DEVICE

Lloyd Paul Aiello  1   2 , Cris Martin P Jacoba  1 , Mohamed Ashraf  1   2 , Jerry D Cavallerano  1   2 , Ann M Tolson  1 , Dorothy Tolls  1 , Jennifer K Sun  1   2 , Paolo S Silva  1   2
Affiliations

INTEGRATING MACULAR OPTICAL COHERENCE TOMOGRAPHY WITH ULTRAWIDE-FIELD IMAGING IN A DIABETIC RETINOPATHY TELEMEDICINE PROGRAM USING A SINGLE DEVICE

Lloyd Paul Aiello et al. Retina. .

Abstract

Purpose: To determine the effect of combined macular spectral-domain optical coherence tomography (SD-OCT) and ultrawide field retinal imaging (UWFI) within a telemedicine program.

Methods: Comparative cohort study of consecutive patients with both UWFI and SD-OCT. Ultrawide field retinal imaging and SD-OOCT were independently evaluated for diabetic macular edema (DME) and nondiabetic macular abnormality. Sensitivity and specificity were calculated with SD-OCT as the gold standard.

Results: Four hundred twenty-two eyes from 211 diabetic patients were evaluated. Diabetic macular edema severity by UWFI was as follows: no DME 93.4%, noncenter involved DME (nonciDME) 5.1%, ciDME 0.7%, ungradable DME 0.7%. SD-OCT was ungradable in 0.5%. Macular abnormality was identified in 34 (8.1%) eyes by UWFI and in 44 (10.4%) eyes by SD-OCT. Diabetic macular edema represented only 38.6% of referable macular abnormality identified by SD-OCT imaging. Sensitivity/specificity of UWFI compared with SD-OCT was 59%/96% for DME and 33%/99% for ciDME. Sensitivity/specificity of UWFI compared with SDOCT was 3%/98% for epiretinal membrane.

Conclusion: Addition of SD-OCT increased the identification of macular abnormality by 29.4%. More than 58.3% of the eyes believed to have any DME on UWF imaging alone were false-positives by SD-OCT. The integration of SD-OCT with UWFI markedly increased detection and reduced false-positive assessments of DME and macular abnormality in a teleophthalmology program.

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Conflict of interest statement

Conflict of Interest: The Joslin Vision Network technology was developed at the Joslin Diabetes Center. A single Monaco retinal imaging device was provided on temporary loan by the manufacturer Optos plc to the Joslin Diabetes Center.

Figures

Figure 1:
Figure 1:
Examples of false positive and false negative detection of central-involved diabetic macular edema on UWFI. Legend: 1A and 1B – False positive. Ultrawide field color retinal image cropped to the posterior pole shows parafoveal microaneurysms (arrow) with area of focal whitening adjacent to fovea (1A). Graders identified the image as having central-involved macular edema based on color images. On SDOCT, no DME is present (1B). 1C and 1D – False negative. Ultrawide field color retinal image cropped to the posterior pole was graded as no DME with good foveal reflex (1C). On SDOCT, there is substantial elevation of the foveal contour (arrow) accompanied by an intraretinal cyst secondary to central-involved DME and the focal epiretinal membrane (1D). Lower-right inset in 1B and 1D shows level of OCT scan along 6 × 6 macular cube (horizontal green line). In both cases, mild nonproliferative diabetic retinopathy was graded due to the presence of hemorrhages and microaneurysms less than standard 2A.
See this image and copyright information in PMC

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