title: Comparison of low-light nonmydriatic digital imaging with 35-mm ETDRS seven-standard field stereo color fundus photographs and clinical examination.
abstract: OBJECTIVE
  To compare agreement between diagnosis of clinical level of diabetic retinopathy (DR) and diabetic macular edema (DME) derived from nonmydriatic fundus images using a digital camera back optimized for low-flash image capture (MegaVision) compared with standard seven-field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs and dilated clinical examination. Subject comfort and image acquisition time were also evaluated.
  
  
  METHODS
  In total, 126 eyes from 67 subjects with diabetes underwent Joslin Vision Network nonmydriatic retinal imaging. ETDRS photographs were obtained after pupillary dilation, and fundus examination was performed by a retina specialist.
  
  
  RESULTS
  There was near-perfect agreement between MegaVision and ETDRS photographs (κ=0.81, 95% confidence interval [CI] 0.73-0.89) for clinical DR severity levels. Substantial agreement was observed with clinical examination (κ=0.71, 95% CI 0.62-0.80). For DME severity level there was near-perfect agreement with ETDRS photographs (κ=0.92, 95% CI 0.87-0.98) and moderate agreement with clinical examination (κ=0.58, 95% CI 0.46-0.71). The wider MegaVision 45° field led to identification of nonproliferative changes in areas not imaged by the 30° field of ETDRS photos. Field area unique to ETDRS photographs identified proliferative changes not visualized with MegaVision. Mean MegaVision acquisition time was 9:52 min. After imaging, 60% of subjects preferred the MegaVision lower flash settings.
  
  
  CONCLUSIONS
  When evaluated using a rigorous protocol, images captured using a low-light digital camera compared favorably with ETDRS photography and clinical examination for grading level of DR and DME. Furthermore, these data suggest the importance of more extensive peripheral images and suggest that utilization of wide-field retinal imaging may further improve accuracy of DR assessment.
authors: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.
authors: Paolo S
authors: PS
authors: Silva
authors: Saloni
authors: S
authors: Walia
authors: Jerry D
authors: JD
authors: Cavallerano
authors: Jennifer K
authors: JK
authors: Sun
authors: Cheri
authors: C
authors: Dunn
authors: Sven-Erik
authors: SE
authors: Bursell
authors: Lloyd M
authors: LM
authors: Aiello
authors: Lloyd Paul
authors: LP
authors: Aiello
mesh_terms: 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 / Q000175:diagnosis*; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008269:Macular Edema / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D010781:Photography / Q000379:methods*; D017216:Telemedicine / Q000379:methods; D055815:Young Adult