title: Clinical evaluation of patients with diabetic retinopathy: accuracy of the Inoveon diabetic retinopathy-3DT system.
abstract: OBJECTIVE
  This study analyzed the accuracy of the Inoveon Diabetic Retinopathy (DR-3DT) system (Inoveon Corp., Oklahoma City, OK), a scalable evaluation method for the management of diabetic retinopathy using high-quality digital retinal imaging.
  
  
  METHODS
  An independent, masked, cross-sectional, clinical validation study.
  
  
  METHODS
  Two hundred ninety adult patients with diabetes from the Chickasaw Nation's Carl Albert Indian Health Facility in Ada, Oklahoma.
  
  
  METHODS
  All participants underwent DRS7 imaging using a Zeiss FF450 fundus camera with images recorded on 35-mm film and a Kodak DCS520 digital camera back. Masked double grading with independent third reader adjudication yielded an Early Treatment Diabetic Retinopathy Study (ETDRS) Final Retinopathy Severity Scale Level (ETDRS Level) and macular edema stage for each eye. The presence of greater-than-or-equal ETDRS Level 53, questionable or definite clinically significant macular edema in either eye, or ungradeable images was defined as a threshold event requiring referral.
  
  
  METHODS
  Accuracy (sensitivity, specificity, predictive values) of the digital system relative to the film "gold standard" on the threshold referral criteria per patient.
  
  
  RESULTS
  All patients with gradeable 35-mm slides from at least one eye were included in this per patient analysis (n = 290). The prevalence of threshold events was 19.3%. The sensitivity of the digital system in detecting threshold events was 98.2% (95% confidence interval [CI], 90.5%-100.0%) and specificity 89.7% (95% CI, 85.1%-93.3%). The positive predictive value was 69.5% and negative predictive value 99.5% for this sample.
  
  
  CONCLUSIONS
  When compared with the "gold standard," Inoveon's DR-3DT system provides highly accurate diabetic retinopathy referral decisions. Given their inherent advantages, high-quality digital imaging systems could replace the film "gold standard" as the basis for scalable, accessible, diabetic retinopathy evaluation.
authors.affiliation: Department of Ophthalmology, Inoveon Corporation, University of Oklahoma Health Sciences Center, 800 N. Research Parkway, Oklahoma City, OK 73104, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Fransen
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Leonard-Martin
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.forename: P Lloyd
authors.initials: PL
authors.lastname: Hildebrand
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D004311:Double-Blind Method; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D008269:Macular Edema / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity