title: Wide-field imaging and OCT vs clinical evaluation of patients referred from diabetic retinopathy screening.
abstract: OBJECTIVE
  Compare wide-field Optomap imaging and optical coherence tomography (OCT) with clinical examination in diabetic retinopathy (DR).
  
  
  METHODS
  Patients referred from Diabetic Eye Screening Programmes to three centres underwent dilated ophthalmoscopy and were assigned a DR grade. Wide-field colour imaging and OCT were then examined by the same clinician at that visit and a combined grade was assigned. Independent graders later reviewed the images and assigned an imaging-only grade. These three grades (clinical, combined, and imaging) were compared. The method that detected the highest grade of retinopathy, including neovascularisation, was determined.
  
  
  RESULTS
  Two thousand and forty eyes of 1023 patients were assessed. Wide-field imaging compared with clinical examination had a sensitivity and specificity of 73% and 96%, respectively, for detecting proliferative DR, 84% and 69% for sight-threatening DR, and 64% and 90% for diabetic macular oedema. Imaging alone found 35 more eyes with new vessels (19% of eyes with new vessels) and the combined grade found 14 more eyes than clinical examination alone.
  
  
  CONCLUSIONS
  Assessment of wide-field images and OCT alone detected more eyes with higher grades of DR compared with clinical examination alone or when combined with imaging in a clinical setting. The sensitivity was not higher as the techniques were not the same, with imaging alone being more sensitive. Wide-field imaging with OCT could be used to assess referrals from DR screening to determine management, to enhance the quality of assessment in clinics, and to follow-up patients whose DR is above the screening referral threshold but does not actually require treatment.
authors.affiliation: Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: V
authors.initials: V
authors.lastname: Manjunath
authors.affiliation: Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: V
authors.initials: V
authors.lastname: Papastavrou
authors.affiliation: Sunderland Eye Infirmary, Sunderland and Institute of Genetic Medicine, Newcastle Upon Tyne, UK.
authors.forename: D H W
authors.initials: DH
authors.lastname: Steel
authors.affiliation: Frimley Park Hospital, Frimley Park, UK.
authors.forename: G
authors.initials: G
authors.lastname: Menon
authors.affiliation: Newcastle University, Newcastle upon Tyne, UK.
authors.forename: R
authors.initials: R
authors.lastname: Taylor
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Peto
authors.affiliation: Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Talks
mesh_terms: D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012171:Retinal Vessels / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity