title: Teleretinal imaging for detection of referable macular degeneration.
abstract: OBJECTIVE
  The purpose of this study was to determine the sensitivity and specificity for detection of referable age-related macular degeneration (AMD) using an existing nonmydriatic telemedicine pathway for diabetic retinopathy screening with comparison to same-day face-to-face examination by a retina specialist.
  
  
  METHODS
  Subjects in this study underwent nonmydriatic and mydriatic digital retinal imaging on the same day as stereoscopic dilated examination of the macula by a retina specialist and the level of AMD was recorded for each eye. Images were graded by two trained readers as nonreferable or referable (AREDS [Age-Related Eye Disease Study] grading of level 3 or greater). Sensitivity and specificity were calculated by comparing referral recommendations between each reader and the retina specialist ("gold standard").
  
  
  RESULTS
  There were 47 subjects (94 eyes) enrolled in the study. Sensitivity for nonreferable AMD with nonmydriatic imaging was 1.0 (reader 1) and 1.0 (reader 2), whereas specificity was 0.75 (reader 1) and 0.91 (reader 2). Sensitivity for referable AMD with nonmydriatic imaging was 0.84 (reader 1) and 0.88 (reader 2), whereas specificity was 0.81 (reader 1) and 0.81 (reader 2).
  
  
  CONCLUSIONS
  Our study showed that nonmydriatic digital retinal imaging had excellent sensitivity and specificity in identifying referable and nonreferable AMD using an existing validated telemedicine pathway for diabetic retinopathy screening.
authors.affiliation: *OD, MS, FAAO †MD, PhD ‡OD, FAAO VA Maine Healthcare System, Augusta, Maine (KSD); and VA Boston Healthcare System, Boston, Massachusetts (BA, VP, DR, PM, AC).
authors.forename: Kyla S
authors.initials: KS
authors.lastname: Duchin
authors.forename: Baharak
authors.initials: B
authors.lastname: Asefzadeh
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Poulaki
authors.forename: Douglas
authors.initials: D
authors.lastname: Rett
authors.forename: Paul
authors.initials: P
authors.lastname: Marescalchi
authors.forename: Anthony
authors.initials: A
authors.lastname: Cavallerano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008268:Macular Degeneration / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D010781:Photography / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D011680:Pupil / Q000187:drug effects; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods*
chemical_list: D009184:Mydriatics