Ultra-widefield imaging adds value for telehealth programs

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A retrospective cohort study found a significantly higher rate of detection of nondiabetic retinopathy findings using ultra-widefield retinal imaging compared with nonmydriatic fundus photography.

By Cheryl Guttman Krader; Reviewed by Paolo Antonio S. Silva, MD

Boston-Results of a study-comparing nonmydriatic ultra-widefield imaging (UWFI) with nonmydriatic fundus photography (NMFP)-further support the idea that UWFI is a useful tool for diabetes ocular telehealth programs, according to investigators.

“We have previously reported that UWFI offers increased efficiency benefits and ability to detect diabetic retinal disease compared with NMFP,” said Paolo Antonio S. Silva, MD, assistant chief of telemedicine, Beetham Eye Institute, Joslin Diabetes Center, Boston.

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“However, as we found in this study, patients with diabetes may have other retinal conditions whether or not they have diabetic retinopathy,” Dr. Silva said. “It is important to be able to identify these pathologies to ensure patients receive the appropriate referrals for eye care.”

The results of this study indicate UWFI can meet that need, and because it allows for evaluation of a greater area of the retina, its use allows for increased detection of lesions that are typically located outside the field captured with traditional nonmydriatic imaging, according to Dr. Silva.

NEXT: Retinal Findings

Retinal findings

In the retrospective study, certified graders performed standardized evaluation looking for nondiabetic retinopathy retinal findings in images obtained with the two techniques in large consecutive cohorts of patients. There were 3,859 patients imaged with NMFP and 3,964 patients subsequently imaged with UWFI. The two groups were well matched with respect to demographic characteristics and insulin use, although mean duration of diabetes was significantly longer in the eyes images with UWFI compared with the NMFP group (13.26 versus 12.34 years).

The results of the image gradings showed that within the subgroups of eyes without diabetic retinopathy, 20% of eyes in the NMFP group and 21% of eyes imaged with UWFI had some retinal abnormality not specifically related to diabetes. Within the overall cohorts, the incidence of a nondiabetic retinopathy finding was significantly higher in the UWFI group compared with eyes imaged with NMFP, 21% versus 19%.

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In terms of specific pathologies, compared with the NMFP group, use of UWFI was associated with significantly higher rates of detection of choroidal nevi (7% versus 5%), chorioretinal atrophy or scarring (1.3% versus 0.6%), retinal tears (0.3% versus 0%), lattice and peripheral degenerations (0.4% versus 0%), and vitreous detachment or floaters (1.8% versus 0%).

Suspicion for glaucoma based on optic nerve head evaluation was also significantly higher in the UWFI cohort compared with eyes imaged with NMFP (11.9% versus 10.2%). There were no significant differences between groups in rates of detection of age-related macular degeneration, hypertensive retinopathy, retinal vein occlusion, retinal arterial occlusion, retinal emboli, macular holes, or asteroid hyalosis.

The images reviewed in the study were from patients participating in a telemedicine program. The NMFP cohort was imaged between Nov. 1, 2011 and March 31, 2012. Patients in the UWFI cohort underwent imaging from April 1, 2012 to June 30, 2013 using a device (Optos P200MA/P200C, Optos plc).

“Although the two imaging techniques were not compared directly in the same cohort, the two study groups represented large consecutive cohorts that were similar in their demographic characteristics,” Dr. Silva said “Therefore, we would expect they should also be similar with respect to their retinal disease findings.”

UWFI also had an advantage over NMFP for having a significantly lower rate of images that could not be graded for diabetic retinopathy (3.9% versus 12.4%) or for diabetic macular edema (5.7% versus 11.7%).

Paolo Antonio S. Silva, MD

E: paoloantonio.silva@joslin.harvard.edu

Dr. Silva is an employee of the Joslin Diabetes Center. The Joslin Diabetes Center has received research grant funding and temporary equipment loans from Optos plc.