title: A comparison of digital nonmydriatic fundus imaging with standard 35-millimeter slides for diabetic retinopathy.
abstract: OBJECTIVE
  The purpose of this study was to compare nonmydriatic digital images with 35-mm slide images for the detection of diabetic retinal findings.
  
  
  METHODS
  Comparative, observational case series.
  
  
  METHODS
  Twenty-two patients with diabetes.
  
  
  METHODS
  Diabetic patients underwent digital (nonmydriatic fundus camera attached to a digital back) and standard dilated 35-mm retinal photography of three areas: posterior pole, nasal retina, and temporal retina. The images were reviewed by a single masked grader for the presence or absence of specific retinal findings.
  
  
  METHODS
  Presence or absence of neovascularization of the disc (NVD), neovascularization elsewhere (NVE), venous beading (VB), nerve fiber layer (NFL) hemorrhage, dot-blot hemorrhage, microaneurysm (MA), clinically significant macular edema, cotton wool spot, intraretinal microvascular anomaly (IRMA), hard exudate (HE), and retinal pigment epithelial (RPE) pigmentary changes.
  
  
  RESULTS
  Forty eyes of 22 patients underwent both imaging procedures. The agreement between image type was highest for IRMA (97.5%) and VB (95%) and lowest for RPE pigmentary changes (65%) and MA (62.5%). Sensitivity ranged from 25% (NVD) to 100% (VB). Specificity ranged from 90% (RPE pigmentary changes) to 100% (NVD, NVE, VB, NFL hemorrhage, HE). Positive predictive value ranged from 50% (IRMA) to 100% (NVD, NVE, HE, NFL, VB). Negative predictive value ranged from 48% (MA) to 100% (IRMA).
  
  
  CONCLUSIONS
  Nonmydriatic digital fundus imaging for detection of diabetic retionopathy has a low sensitivity rate and a high specificity rate and is less clinically useful than standard dilated 35-mm fundus slide images.
authors.affiliation: Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Lim
authors.forename: L
authors.initials: L
authors.lastname: LaBree
authors.forename: T
authors.initials: T
authors.lastname: Nichols
authors.forename: I
authors.initials: I
authors.lastname: Cardenas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005189:False Positive Reactions; D005654:Fundus Oculi; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D010781:Photography / Q000379:methods / Q000592:standards*; D011237:Predictive Value of Tests; D011680:Pupil / Q000187:drug effects; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology; D012166:Retinal Hemorrhage / Q000175:diagnosis; D015861:Retinal Neovascularization / Q000175:diagnosis; D012171:Retinal Vessels / Q000473:pathology; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted