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Brief Report |

Comparison of Nondiabetic Retinal Findings Identified With Nonmydriatic Fundus Photography vs Ultrawide Field Imaging in an Ocular Telehealth Program

Paolo S. Silva, MD1,2,3; Jerry D. Cavallerano, OD, PhD1,2; Nour Maya N. Haddad, MD, MS1; Dorothy Tolls, OD1; Komal Thakore, OD1; Bina Patel, OD1,4; Mina Sehizadeh, OD1; Ann M. Tolson, BS1; Jennifer K. Sun, MD, MPH1; Lloyd Paul Aiello, MD, PhD1,2
[+] Author Affiliations
1Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
3Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
4New England College of Optometry, Boston, Massachusetts
JAMA Ophthalmol. 2016;134(3):330-334. doi:10.1001/jamaophthalmol.2015.5605.
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Importance  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.

Observation  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 and Relevance  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.

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Figure.
Multifield Nonmydriatic Fundus Photography Compared With Ultrawide Field Imaging

A 200° retinal ultrawide field image with the 100° image area outlined in yellow. The circles (F1, F2: 30° fields; NM-1, NM-2, NM-3: 45° fields) indicate the area imaged via multifield nonmydriatic fundus photography. Dotted lines highlight a horseshoe-shaped retinal tear; inset shows a ×2.25 magnified view of the tear. F indicates field; NM, nonmydriatic.

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