title: Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy.
abstract: OBJECTIVE
  To compare nonmydriatic stereoscopic Optomap ultrawide field images with dilated stereoscopic Early Treatment Diabetic Retinopathy Study 7-standard field 35-mm color 30-degree fundus photographs (ETDRS photography) and clinical examination for determining diabetic retinopathy (DR) and diabetic macular edema (DME) severity.
  
  
  METHODS
  Single-site, prospective, comparative, instrument validation study.
  
  
  METHODS
  One hundred three diabetic patients (206 eyes) representing the full spectrum of DR severity underwent nonmydriatic ultrawide field 100-degree and 200-degree imaging, dilated ETDRS photography, and dilated fundus examination by a retina specialist. Two independent readers graded images to determine DR and DME severity. A third masked retina specialist adjudicated discrepancies.
  
  
  RESULTS
  Based on ETDRS photography (n = 200), the results were as follows: no DR (n = 25 eyes [12.5%]), mild nonproliferative DR (NPDR; 47 [23.5%]), moderate NPDR (61 [30.5%]), severe NPDR (11 [5.5%]), very severe NPDR (3 [1.5%]), and proliferative DR (52 [2.5%]). One (0.5%) eye was ungradable and 6 eyes did not complete ETDRS photography. No DME was found in 114 eyes (57.0%), DME was found in 28 eyes (14.0%), and clinically significant DME was found in 47 eyes (23.5%), and 11 (5.5%) eyes were ungradable. Exact DR severity agreement between ultrawide field 100-degree imaging and ETDRS photography occurred in 84%, with agreement within 1 level in 91% (K(W) = 0.85; K = 0.79). Nonmydriatic ultrawide field images exactly matched clinical examination results for DR in 70% and were within 1 level in 93% (K(W) = 0.71; K = 0.61). Nonmydriatic ultrawide field imaging acquisition time was less than half that of dilated ETDRS photography (P < .0001).
  
  
  CONCLUSIONS
  Nonmydriatic ultrawide field images compare favorably with dilated ETDRS photography and dilated fundus examination in determining DR and DME severity; however, they are acquired more rapidly. If confirmed in broader diabetic populations, nonmydriatic ultrawide field imaging may prove to be beneficial in DR evaluation in research and clinical settings.
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, and the Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02115, USA. paoloantonio.silva@joslin.harvard.edu
authors.forename: Paolo S
authors.initials: PS
authors.lastname: Silva
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Cavallerano
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Sun
authors.forename: Jason
authors.initials: J
authors.lastname: Noble
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Aiello
authors.forename: Lloyd Paul
authors.initials: LP
authors.lastname: Aiello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D009885:Ophthalmology; D010781:Photography / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D013038:Specialization; D055815:Young Adult
chemical_list: D009184:Mydriatics