title: Comparison of Nondiabetic Retinal Findings Identified With Nonmydriatic Fundus Photography vs Ultrawide Field Imaging in an Ocular Telehealth Program.
abstract: OBJECTIVE
  Ultrawide field imaging (UWFI) is increasingly being used in teleophthalmology settings. Given the greater area of the retina imaged, we evaluated the ability of UWFI vs nonmydriatic fundus photography (NMFP) to detect nondiabetic retinal findings in a teleophthalmology program.
  
  
  METHODS
  We conducted a retrospective single-center comparative cohort study from January 1, 2011, to June 30, 2013, imaging 3864 and 3971 consecutive teleophthalmology patients (7728 and 7942 eyes) using NMFP and UWFI, respectively. Standard diabetic retinopathy evaluation and nondiabetic findings were compared between the 2 imaging modalities. In patients without diabetic retinopathy (2243 by NMFP and 2252 by UWFI), the rate of identification of nondiabetic findings by NMFP (451 patients [20.1%]) and UWFI (490 [21.8%]) were comparable (P = .19). Ultrawide field imaging increased the identification of choroidal nevi by 27% (406 eyes [5.3%] by NMFP vs 545 eyes [6.9%] by UWFI; P < .001) and chorioretinal atrophy or scarring by 116% (50 eyes [0.6%] by NMFP vs 101 eyes [1.3%] by UWFI; P < .001). No peripheral retinal findings were identified with NMFP, while UWFI detected 25 retinal tears (0.3%; P < .001), 54 lattice and peripheral degenerations (0.7%; P < .001), and 142 cases of vitreous detachment or floaters (1.8%; P < .001). Data analysis was performed from November 1, 2013, to May 1, 2014.
  
  
  CONCLUSIONS
  In eyes without diabetic retinopathy, approximately 20% may have ocular findings identified on retinal imaging, which emphasizes the role of retinal imaging in patients with diabetes mellitus type 1 and type 2 regardless of the severity of retinopathy. In this cohort, UWFI increased the identification of peripheral retinal and vitreous pathologic findings.
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts3Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, University of the Philippines, M.
authors.forename: Paolo S
authors.initials: PS
authors.lastname: Silva
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Cavallerano
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Nour Maya N
authors.initials: NM
authors.lastname: Haddad
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Tolls
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Komal
authors.initials: K
authors.lastname: Thakore
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts4New England College of Optometry, Boston, Massachusetts.
authors.forename: Bina
authors.initials: B
authors.lastname: Patel
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Mina
authors.initials: M
authors.lastname: Sehizadeh
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Tolson
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Sun
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lloyd Paul
authors.initials: LP
authors.lastname: Aiello
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage*; D010781:Photography / Q000379:methods*; D011680:Pupil / Q000187:drug effects; D012164:Retinal Diseases / Q000175:diagnosis; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D019113:Telepathology / Q000379:methods*
chemical_list: D009184:Mydriatics