title: Use of nonmydriatic spectral-domain optical coherence tomography for diagnosing diabetic macular edema.
abstract: OBJECTIVE
  To evaluate the accuracy of 3 spectral-domain (SD) optical coherence tomography (OCT) devices (Topcon 3D-1000 [Topcon]; Cirrus HD [Carl Zeiss Meditec, Inc], and Spectralis OCT [Heidelberg Engineering]) before and after mydriasis for the diagnosis of diabetic macular edema.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Sixty-two eyes of 62 consecutive patients with diabetes without recent loss of vision referred for retinal control were assessed. Two scans were performed for each SD OCT instrument. Central retinal thickness was measured before and after pupil dilation. Pupil dynamic was studied using pMetrics pupillometer (iVIS Technologies), and lens opacity was measured by Pentacam densitometry (Oculus). The diagnostic accuracy of SD OCT devices was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the effect of pupil size and lens opacity on the reliability of SD OCT in the acquisition of adequate images.
  
  
  RESULTS
  The area under the receiver operating characteristic curve for the Topcon 3D OCT device was 0.84, that for the Cirrus HD OCT device was 0.93, and that for the Spectralis OCT device was 0.91. Significant differences in area under the receiver operating characteristic curve before and after pupillary dilatation were not found. Sensitivity and specificity associated with the cutoff value for the best performance were 82% and 74% for the Topcon 3D OCT device, 90% and 87% for the Cirrus HD OCT device, and 90% and 84% for the Spectralis OCT device, respectively. The Topcon 3D OCT device had an 11.3% segmentation algorithm failure rate for the central millimeter of the fovea, and the nuclear lens density was significantly greater in these eyes than in those without failure (17.1 ± 1.1 mm vs 10.4 ± 0.2 mm; P < .05).
  
  
  CONCLUSIONS
  SD OCT is a useful tool to detect and to measure diabetic macular edema without the need for pupil dilatation.
authors: Retinal Unit, Department of Ophthalmology, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain. javierlara@me.com
authors: Francisco Javier Lara
authors: FJ
authors: Medina
authors: Carmen Ispa
authors: CI
authors: Callén
authors: Gema
authors: G
authors: Rebolleda
authors: Francisco J
authors: FJ
authors: Muñoz-Negrete
authors: María J Ispa
authors: MJ
authors: Callén
authors: Fernando González
authors: FG
authors: del Valle
mesh_terms: D000465:Algorithms; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008269:Macular Edema / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D011680:Pupil / Q000187:drug effects / Q000502:physiology; D012372:ROC Curve; D015203:Reproducibility of Results; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
chemical_list: D009184:Mydriatics