Comparison of image-assisted versus traditional fundus examination

Figures & data

Figure 1 Ultrawide field scanning laser ophthalmoscope (Optomap^®) image.

Note: Areas 1–9 are delineated to denote location of lesions during image review (Copyright Optos, All rights reserved, reprinted with permission).

Image 1 Nonmydriatic, ultrawide field image of a peripheral retinal hemorrhage adjacent to an area of retinal thinning (area in circle) in a 26-year-old, healthy, asymptomatic subject.

Notes: The insert is a green laser channel view of the same peripheral hemorrhage. Small yellow artifact at center of image and eyelashes at lower edge of image. Brightness and contrast of image have been enhanced to increase visibility of lesion.

Table 1 Prevalence of lesions (n = 170, 339 eyes)*

Region and lesion	Prevalence
Optic disc
Suspicious cupping‡	27.1% (92)
Staphyloma	5.9% (20)
Posterior pole/macula
Drusen	18.9% (64)
RPE changes§	11.8% (40)
Hemorrhage	2.4% (8)
Scar	0.88% (3)
Choroidal nevus	4.72% (16)
Mid-to-peripheral retina
Drusen	14.5% (49)
Peripheral retinal degeneration||	45.1% (153)
Hemorrhage	5.9% (20)
Scar	3.8% (13)
Choroidal nevus	5.9% (20)
Cobblestone	6.19% (21)
Retinal hole or tear	4.4% (15)
Vitreoretinal interface abnormality	37.8% (128)
Vitreous	28.6% (97)

Notes:

* One subject missing OS data;

‡ defined as 0.50 or greater cup to disc ratio, 0.20 or greater asymmetry between OD and OS, and or notching;

§ retinal pigment epithelial (RPE) changes including RPE hypertrophy, RPE hyperplasia and RPE hypoplasia;

|| including RPE hypertrophy, RPE hyperplasia, RPE hypoplasia, lattice, snail tracking, cystoid degeneration, and other peripheral degenerations (pigmented or nonpigmented of size 25 pixels or greater);

* numerators indicate the number of observations of lesions present as determined by both methods or in the case of disagreement, by adjudication.

Table 2 Exact agreement between traditional and image-assisted ophthalmoscopy

Region and lesion	Exact agreement OD/OS	Kappa OD/OS
Optic disc region
Suspicious cupping	87%/88%	0.64/0.68
Staphyloma	98%/96%	0.79/0.73
Posterior pole/macula
Drusen	85%/86%	0.42/0.48
RPE change	92%/87%	0.63/0.44
Hemorrhage	98%/98%	0.66/0.76
Scar	99%/99%	0.80/0.86
Choroidal nevus	95%/95%	0.30/0.33
Mid-to-peripheral retina
Drusen	88%/89%	0.37/0.44
Peripheral retinal degeneration	74%/77%	0.45/0.55
Hemorrhage	95%/94%	0.32/0.34
Scar	99%/96%	0.85/0.61
Choroidal nevus	94%/93%	0.26/0.42
Cobblestone	96%/96%	0.65/0.72
Retinal hole or tear	97%/96%	0.60/0.52
Vitreoretinal interface abnormality	73%/73%	0.41/0.39
Vitreous	82%/82%	0.53/0.53

Note: P < 0.001 for all lesions OD/OS.

Table 3 Proportion of observations agreeing with adjudication (n = 170, 339 eyes)*

Region and lesion	Image-assisted		Traditional
	Lesion present	Lesion absent	Lesion present	Lesion absent
Optic disc
Suspicious cupping‡	88% (81/92)	98.4% (243/247)	76.1% (70/92)	97.2% (240/247)
Staphyloma	100% (20/20)	99.7% (318/319)	70% (14/20)	99.1% (316/319)
Region total	90.2% (101/112)	99.1% (561/566)	75% (84/112)	98.2% (556/566)
Posterior pole/macula
Drusen	90.6% (58/64)	96.7% (266/275)	43.8% (28/64)	100% (275/275)
RPE changes§	82.5% (33/40)	98% (293/299)	70% (28/40)	95.3% (285/299)
Hemorrhage	100% (8/8)	99.4% (329/331)	62.5% (5/8)	99.7% (330/331)
Scar	100% (3/3)	100% (336/336)	66.7% (2/3)	99.7% (335/336)
Choroidal nevus	100% (16/16)	99.4% (321/323)	6.25% (1/16)	100% (323/323)
Region total	90.1% (118/131)	98.8% (1545/1564)	48.9% (64/131)	99% (1548/1564)
Mid-to-peripheral retina
Drusen	91.8% (45/49)	98.3% (285/290)	28.6% (14/49)	99.7% (289/290)
Peripheral retinal degeneration||	88.9% (136/153)	94.6% (176/186)	73.9% (113/153)	89.2% (166/186)
Hemorrhage	90% (18/20)	99.4% (317/319)	15% (3/20)	100% (319/319)
Scar	92.3% (12/13)	99.7% (325/326)	69.2% (9/13)	99.4% (324/326)
Choroidal nevus	90% (18/20)	99.4% (317/319)	30% (6/20)	98.4% (314/319)
Cobblestone	100% (21/21)	99.7% (317/318)	66.7% (14/21)	98.1% (312/318)
Retinal hole or tear	73.3% (11/15)	99.4% (322/324)	60% (9/15)	99.4% (322/324)
Vitreoretinal interface abnormality	92.2% (118/128)	93.8% (198/211)	54.7% (70/128)	94.8% (200/211)
Region total	90.5% (379/419)	98.4% (2257/2293)	56.8% (238/419)	98% (2246/2293)
Vitreous	93.8% (91/97)	97.1% (235/242)	56.7% (55/97)	96.7% (234/242)

Notes:

* One subject missing OS data;

‡ defined as 0.50 or greater cup to disc ratio, 0.20 or greater asymmetry between OD and OS and or presence of notching;

§ including retinal pigment epithelial (RPE) hypertrophy, RPE hyperplasia, and RPE hypoplasia;

|| includes RPE hypertrophy, RPE hyperplasia, RPE hypoplasia, lattice, snail tracking, cystoid degeneration, and other peripheral degenerations (pigmented or nonpigmented of size 25 pixels or greater);

* numerators indicate the number of observations of lesion presence by the relevant method and denominators indicate the number of observations according to either/both methods, or in the case of disagreement, adjudication.

Table 4 Evaluation of discordant results

Region and lesion	Image-assisted correct*	N	P value‡
Optic disc
Suspicious cupping	28	42	0.04
Staphyloma	9	10	0.06
Posterior pole/macula
Drusen	35	49	0.004
RPE changes	25	37	0.04
Hemorrhage	4	6	0.49
Scar	2	2	–
Choroidal nevus	15	17	0.01
Mid-to-peripheral retina
Drusen	33	39	<0.001
Peripheral retinal degeneration	57	81	<0.001
Hemorrhage	16	19	0.01
Scar	6	8	0.229
Choroidal nevus	19	23	0.007
Cobblestone	13	14	0.02
Retinal hole or tear	7	12	0.59
Vitreoretinal interface abnormality	69	92	<0.001
Vitreous	47	57	<0.001

Notes:

* Image-assisted results correct and traditional method incorrect, per adjudication;

‡ test of proportions via generalized estimating equations.