Screening for diabetic retinopathy using digital colour photography and oral fluorescein angiography

Newsom, Richard; Moate, Ben; Casswell, Tony

doi:10.1038/eye.2000.146

Cited by 24 publications

(15 citation statements)

References 24 publications

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“…Increasingly, techniques that will objectively assess sight-threatening diabetic retinopathy as part of a structured screening programme are being sought. 11,12 Oral angiography is convenient and acceptable to patients and therefore meets many of the criteria that such a system must fulfill.…”

Section: Discussionmentioning

confidence: 99%

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography

Squirrell

Dinakaran

Dhingra

et al. 2004

Eye

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Aim To compare the performance of oral fundus fluorescein angiography with a confocal scanning laser ophthalmoscope (SLO) with intravenous fundus fluorescein angiography (IVFFA) with a fundus camera in the assessment of sight-threatening diabetic retinopathy. Patients and methods A total of 25 patients undergoing IVFFA to investigate their diabetic retinopathy were recruited. Participants returned 1 week later and an oral angiogram with the SLO was performed. Six facets of the oral and intravenous angiograms were scored and compared: visualization of the foveal avascular zone (FAZ); branch retinal identification; macular leakage; identification of microaneurysms in areas of macular leakage; peripheral nonperfusion, and leakage from neovascular complexes. Results Compared to IVFFA, the FAZ was unreliably visualized with oral angiography (Kappa 0.1, 95% CI 0-0.3). In contrast, macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), identification of microaneurysms in areas of macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), and neovascular complexes (Kappa 1.0) were reliably seen. Analysis of the visualization of peripheral nonperfusion was complicated by the finding that profuse dye leakage from neovascular complexes obscured the view of the peripheral retina. If the five angiograms in which this occurred were excluded, oral angiography identified 23 of the 24 eyes in which significant nonperfusion was found on IVFFA. Conclusion Oral angiography with the SLO can provide high-quality angiograms that allow judgments to be made about the presence of treatable diabetic maculopathy, proliferative diabetic retinopathy, and peripheral nonperfusion. In the presence of coexisting macular oedema, it proved to be an unreliable technique with which to investigate foveal ischaemia.

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Section: Discussionmentioning

confidence: 99%

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography

Squirrell

Dinakaran

Dhingra

et al. 2004

Eye

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“…In addition, it is not very specific; it will detect cataracts and age-related macular degeneration, which is not the purpose of the screening. Finally, macular edema is preferably detected and treated before visual acuity loss occurs (19). In our study, visual acuity measurement had low sensitivity in the detection of macular edema.…”

Section: Two-field Photography In Diabetic Retinopathy Screeningmentioning

confidence: 96%

Two-Field Photography Can Identify Patients With Vision-Threatening Diabetic Retinopathy

2001

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OBJECTIVE -To compare the effectiveness of two 45°photographic fields per eye in the screening for diabetic retinopathy with the routine ophthalmologist's examination and to study the effectiveness of visual acuity measurement in the detection of diabetic macular edema.RESEARCH DESIGN AND METHODS -Type 1 and 2 diabetic patients without a known history of more than minimal retinopathy (n ϭ 469) had a routine examination by an ophthalmologist, including visual acuity measurement, indirect retinoscopy, and biomicroscopy. At the same time, two-field nonstereoscopic retinal photographs were made of both eyes and assessed in a masked fashion by a retinal specialist. The results were compared. RESULTS -The prevalence was 4.3% for vision-threatening retinopathy and 24% for any retinopathy. The sensitivity of two-field photography in identifying diabetic patients with sightthreatening retinopathy was 95% (specificity 99%) and sensitivity for detecting any retinopathy was 83% (specificity 88%). The percentage of referrals to an ophthalmologist was 6.2%. All patients with macular edema detected by biomicroscopy were classified as having visionthreatening retinopathy on the photographs.CONCLUSIONS -Two-field retinal photography is a promising alternative to the routine ophthalmologist's examination in the screening for diabetic retinopathy. Visual acuity measurement is not a sensitive tool for the detection of macular edema. Screening for diabetic retinopathy using two-field retinal photography is feasible in a primary care setting and can substantially lower the number of ophthalmic referrals. Diabetes Care 24:2086 -2090, 2001D iabetic retinopathy is currently the leading cause of blindness in the western world in people aged 20 -65 years (1). Several studies indicate that severe visual loss by diabetic retinopathy is caused to a large extent by lack of adequate screening (2). When not discovered before vision loss occurs, the disease usually progresses severely, and at that point, laser treatment is rarely effective in restoring vision (3,4). Therefore, it is vital to detect retinopathy in time to prevent the permanent and destroying effects of this disease. Regular fundus examinations in mydriasis are recommended for all patients with diabetes (5).Screening in the Netherlands is typically retinoscopy through dilated pupils performed by an ophthalmologist. An alternative is retinal photography. The retina is photographed through a dilated pupil, and the photographs are evaluated by an expert. This method of screening is very suitable for use in a primary care setting. Screening in a primary care setting could dramatically reduce the number of premature referrals to an ophthalmologist. It will favor accessibility of the screening and increase compliance.The gold standard for evaluating diabetic retinopathy is the grading of stereoscopic photographs of seven fields (6). Several studies have demonstrated that a reduced number of photographic fields can provide sufficient information in clinical trials and epidemiological stu...

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“…Oral FA was shown to detect CSME with a sensitivity of 89% and specificity 80% 473 . However, the current practical alternative to FA, OCT, has effectively superseded oral FA because of its improved accuracy in defining and quantifying DME with negligible morbidity.…”

Section: Oral Fluorescein Angiographymentioning

confidence: 99%

“…Several studies assessed the use of oral fluorescein angiography (FA) [473][474][475][476][477][478] , in addition to fundus photography, to identify STR and DME. Oral FA was shown to detect CSME with a sensitivity of 89% and specificity 80% 473 .…”

Section: Oral Fluorescein Angiographymentioning

confidence: 99%

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

Foreman

Keel

Xie

et al. 2017

Medical Journal of Australia

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Screening for diabetic retinopathy using digital colour photography and oral fluorescein angiography

Abstract: This pilot study has shown that both digital colour photography and OFA compare well with conventional methods for diabetic retinopathy screening. The results encourage the further evaluation of OFA in the screening for diabetic maculopathy.

Cited by 24 publications

References 24 publications

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography

Two-Field Photography Can Identify Patients With Vision-Threatening Diabetic Retinopathy

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

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