Screening and follow-up of diabetic retinopathy using a new mosaic 9-field fundus photography system.
OBJECTIVE
To evaluate the clinical usefulness of a newly developed fundus photographing system and assess its applicability to telemedicine.


METHODS
Nine overlapping 45 degrees fundus photographs were taken by a new camera equipped with nine internal fixation targets to provide standardized 9-field photographs. The digitally stored images were either edited in 3x3 form or reconstructed as collage (9F) and compared to the ophthalmological examination (OP) and single-field non-mydriatic photography (SC). In telemedicine, 9-field images derived from 61 adolescent diabetics were sent to ophthalmologists over an analog phone line.


RESULTS
The sensitivities of the examinations by 9F without and with mydriasis (78 and 82%) were equivalent to OP (84%) and superior to SC (64%). The diagnosis of severity by 9F was also comparable to those by OP, whereas SC tended to underestimate the severity. An average of 1 min 19 s was required to send one edited 9-field photography (average size 259+/-30 KB) over the Internet. Twelve of these eyes were diagnosed as diabetic retinopathy on a desktop monitor whereas SC gave only seven.


CONCLUSIONS
This new 9-field fundus photography system can be appropriate for the screening and follow-up of diabetic retinopathy in adult and adolescent diabetic subjects, especially when applied to telemedicine over the Internet.
Shiba
Teruo
T
Department of Internal Medicine, Diabetes Care Division, Mitsui Memorial Hospital, One Kanda-Izumicho, Chiyodaku, 1018643, Tokyo, Japan. shiba-ogikubo@pop01.odn.ne.jp
Yamamoto
Teiko
T
Seki
Utako
U
Utsugi
Noriko
N
Fujita
Kyoko
K
Sato
Yukihiro
Y
Terada
Hiroko
H
Sekihara
Hisahiko
H
Hagura
Ryoko
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; D005451:Fluorescein Angiography / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008403:Mass Screening; D008875:Middle Aged; D011680:Pupil / Q000502:physiology; D012680:Sensitivity and Specificity