Wide-field imaging and OCT vs clinical evaluation of patients referred from diabetic retinopathy screening

Eye (Lond). 2015 Mar;29(3):416-23. doi: 10.1038/eye.2014.320. Epub 2015 Jan 16.


Purpose: Compare wide-field Optomap imaging and optical coherence tomography (OCT) with clinical examination in diabetic retinopathy (DR).

Methods: Patients referred from Diabetic Eye Screening Programmes to three centres underwent dilated ophthalmoscopy and were assigned a DR grade. Wide-field colour imaging and OCT were then examined by the same clinician at that visit and a combined grade was assigned. Independent graders later reviewed the images and assigned an imaging-only grade. These three grades (clinical, combined, and imaging) were compared. The method that detected the highest grade of retinopathy, including neovascularisation, was determined.

Results: Two thousand and forty eyes of 1023 patients were assessed. Wide-field imaging compared with clinical examination had a sensitivity and specificity of 73% and 96%, respectively, for detecting proliferative DR, 84% and 69% for sight-threatening DR, and 64% and 90% for diabetic macular oedema. Imaging alone found 35 more eyes with new vessels (19% of eyes with new vessels) and the combined grade found 14 more eyes than clinical examination alone.

Conclusions: Assessment of wide-field images and OCT alone detected more eyes with higher grades of DR compared with clinical examination alone or when combined with imaging in a clinical setting. The sensitivity was not higher as the techniques were not the same, with imaging alone being more sensitive. Wide-field imaging with OCT could be used to assess referrals from DR screening to determine management, to enhance the quality of assessment in clinics, and to follow-up patients whose DR is above the screening referral threshold but does not actually require treatment.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetic Retinopathy / diagnosis*
  • Diagnostic Techniques, Ophthalmological*
  • Humans
  • Physical Examination / methods*
  • Prospective Studies
  • Reproducibility of Results
  • Retinal Vessels / pathology*
  • Sensitivity and Specificity
  • Tomography, Optical Coherence / methods*
  • Visual Acuity