Comparison of image-assisted versus traditional fundus examination

Abstract

Background

The purpose of this study was to evaluate the ability of image-assisted fundus examination to detect retinal lesions compared with traditional fundus examination.

Methods

Subjects were imaged using a nonmydriatic ultrawide field scanning laser ophthalmoscope. After imaging, subjects underwent both a traditional and an image-assisted fundus examination, in random order. During the image-assisted method, ultrawide field scanning laser ophthalmoscopic images were reviewed in conjunction with a dilated fundus examination. Lesions detected by each method were assigned to one of three regions, ie, optic disc, posterior pole/macula, or mid-to-peripheral retina. Discrepancies between the image-assisted and the traditional examination methods were adjudicated by a retinal ophthalmologist.

Results

In total, 170 subjects (339 eyes) were recruited. Agreement between image-assisted and traditional fundus examination varied by lesion type and was excellent for staphyloma (kappa 0.76), fair for suspicious cupping (kappa 0.66), drusen in the posterior pole/macula and mid-to-peripheral retina (0.45, 0.41), retinal pigment epithelial changes in the posterior pole/macula (0.54), peripheral retinal degeneration (0.50), cobblestone (0.69), vitreoretinal interface abnormalities (0.40), and vitreous lesions (0.53). Agreement was poor for hemorrhage in the mid-to-peripheral retina (kappa 0.33), and nevi in the mid-to-peripheral retina (0.34). When the methods disagreed, the results indicated a statistically significant advantage for the image-assisted examination in detecting suspicious cupping (P = 0.04), drusen in the posterior pole/macula and mid-to-peripheral retina (P = 0.004, P < 0.001), retinal pigment epithelial changes in the posterior pole/macula (P = 0.04), nevi in the posterior pole/macula and mid-to-peripheral retina (P = 0.01, P = 0.007), peripheral retinal degeneration (P < 0.001), hemorrhage in the mid-to-peripheral retina (P = 0.01), and vitreous lesions (P < 0.001).

Conclusion

Image-assisted fundus examination may enhance detection of retinal lesions compared with traditional fundus examination alone.

Keywords:

• imaging
• ultrawide field
• image-assisted fundus examination

Acknowledgments

The authors would like to thank all those who contributed to the work presented in this paper, including Julie De Vita, William Sleight, and Sarah Dougherty Wood, who served as study investigators. Rebecca Gass served as patient care coordinator. Thanks are also extended to Jerry Cavallerano for his review of the manuscript. The National Institute for Health Research Biomedical Research Centre in Ophthalmology provided funding for Tunde Peto.

Disclosure

Optos Plc Scotland provided research funding for this study. None of the authors have any financial interest in Optos Plc. Part of this manuscript was presented as a poster at the Association for Research in Vision and Ophthalmology Annual Meeting, Fort Lauderdale, FL, May 3, 2010.