title: Comparison between Early Treatment Diabetic Retinopathy Study 7-field retinal photos and non-mydriatic, mydriatic and mydriatic steered widefield scanning laser ophthalmoscopy for assessment of diabetic retinopathy.
abstract: OBJECTIVE
  To compare non-mydriatic, mydriatic and steered mydriatic widefield retinal images with mydriatic 7-field Early Treatment Diabetic Retinopathy Study (ETDRS)-standards in grading diabetic retinopathy (DR).
  
  
  METHODS
  We examined 95 patients (190 eyes) with type 1 diabetes. A non-mydriatic, a mydriatic and four steered mydriatic 200° widefield retinal images were captured (Optos 200Tx, Optos plc, Dunfermline, Scotland) and compared to mydriatic 7-field 45° ETDRS images (Topcon 3D OCT-2000, Topcon, Tokyo, Japan). Images were graded for DR according to ETDRS-protocol by a trained and certified grader masked to the results of the corresponding grading. For agreement kappa-statistics were used.
  
  
  RESULTS
  Exact level agreement with 7-field images was found in 76.3%, 76.1% and 70.7% for non-mydriatic, mydriatic and steered mydriatic widefield images, respectively. Corresponding values for one-level agreement were 99.0%, 98.9% and 99.5%, respectively. Non-mydriatic matched mydriatic widefield images almost fully with exact and one-level agreement of 96.8% and 100.0%, respectively. Mydriatic steered images resulted in higher grading in 24 eyes.
  
  
  CONCLUSIONS
  Widefield images matched 7-field images favorably. Widefield images can be captured without pupil-dilation and only one image is needed. However, because of overlapping eyelashes and distortion some lesion might be missed. Mydriatic steered images in selected cases may solve some of these problems.
authors.affiliation: Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; The Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: Malin.Lundberg.Rasmussen@rsyd.dk.
authors.forename: Malin L
authors.initials: ML
authors.lastname: Rasmussen
authors.affiliation: Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; The Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark. Electronic address: Rebecca.Broe@rsyd.dk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Broe
authors.affiliation: Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; The Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: Ulrik.Frydkjaer-Olsen@rsyd.dk.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Frydkjaer-Olsen
authors.affiliation: Department of Pediatrics E, Herlev Hospital, Turkisvej 14, DK-2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Electronic address: Birthe.Susanne.Olsen@regionh.dk.
authors.forename: Birthe S
authors.initials: BS
authors.lastname: Olsen
authors.affiliation: Department of Pediatrics E, Herlev Hospital, Turkisvej 14, DK-2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Electronic address: Henrik.Bindesboel.Mortensen@regionh.dk.
authors.forename: Henrik B
authors.initials: HB
authors.lastname: Mortensen
authors.affiliation: The NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL institute of Ophthalmology, 162 City Rd, London EC1V 2PD, United Kingdom; The Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: Tunde.Peto@moorfields.nhs.uk.
authors.forename: Tunde
authors.initials: T
authors.lastname: Peto
authors.affiliation: Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; The Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: Jakob.Grauslund@rsyd.dk.
authors.forename: Jakob
authors.initials: J
authors.lastname: Grauslund
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics; D019721:Ophthalmoscopes; D009887:Ophthalmoscopy / Q000379:methods*; D010781:Photography / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence / Q000295:instrumentation / Q000379:methods*
chemical_list: D009184:Mydriatics
keywords: Comparative study; Diabetic retinopathy; Photography; Screening; Type 1 diabetes