title: Evaluation of digital fundus images as a diagnostic method for surveillance of diabetic retinopathy.
abstract: OBJECTIVE
  The goal was to evaluate a digital imaging system for diagnosing and grading diabetic retinopathy (DR) and cystoid macular edema (CME).
  
  
  METHODS
  A single 45 degrees, nonmydriatic, digital color photograph was taken of 231 eyes of 120 patients with diabetes mellitus. The images were graded for DR and CME by a remote ophthalmologist, and the results were compared with dilated ophthalmoscopy performed by a retina specialist.
  
  
  RESULTS
  For DR, the level of agreement between digital image review and ophthalmoscopy was moderate (kappa = 0.44). The sensitivity and specificity of digital image review were 0.60 and 1.00, respectively. For CME, the level of agreement was moderate (kappa = 0.60). The sensitivity and specificity of digital image review were 0.60 and 0.99, respectively.
  
  
  CONCLUSIONS
  A single 45 degrees, nonmydriatic, digital image is not reliable as the sole modality for DR screening. However, with modifications, it may be useful where access to an experienced ophthalmologist is limited.
authors.affiliation: Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
authors.forename: Dal W
authors.initials: DW
authors.lastname: Chun
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bauer
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Ward
authors.forename: John S B
authors.initials: JS
authors.lastname: Dick
authors.forename: Kraig S
authors.initials: KS
authors.lastname: Bower
mesh_terms: D000328:Adult; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000208:ethnology; D004219:District of Columbia; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008269:Macular Edema / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D008889:Military Personnel; D010781:Photography; D011446:Prospective Studies; D042262:Retinoscopy / Q000379:methods*