The enitivity and pecificity of ingle-field nonmydriatic monochromatic digital fundu photography with remote image interpretation for diabetic retinopathy creening: a comparion with ophthalmocopy and tandardized mydriatic color photography

PURPOE: To evaluate ingle-field digital monochromatic nonmydriatic fundu photography a an adjunct in the creening of diabetic retinopathy. DEIGN: Propective, comparative, obervational cae erie. METHOD: Patient with type I and type II diabete mellitu (n = 197) were equentially evaluated by three different technique: ingle-field digital monochromatic nonmydriatic photography; dilated ophthalmocopy by an ophthalmologit; and even Early Treatment Diabetic Retinopathy tudy (ETDR) tandardized 35-mm color tereocopic mydriatic image. The even tereocopic color photograph erved a the reference tandard and were compared with either ophthalmocopy or a ingle digital photograph tranmitted electronically to a reading ite. Level of agreement were determined by κ analye. The enitivity and pecificity of the three method were compared baed on a threhold for referral to further ophthalmologic evaluation (ETDR level ≥35). REULT: There wa highly ignificant agreement (κ = 0.97, P = .0001) between the degree of retinopathy detected by a ingle nonmydriatic monochromatic digital photograph and that een in even tandard 35-mm color tereocopic mydriatic field. The enitivity of digital photography compared with color photography wa 78%, with a pecificity of 86%. Agreement wa poor (κ = 0.40, P = .0001) between mydriatic ophthalmocopy and the even-field tandard 35-mm color photograph. enitivity of ophthalmocopy compared with color photography wa 34%, with a pecificity of 100%. CONCLUION: A ingle nonmydriatic monochromatic wide-field digital photograph of the dik and macula wa more enitive for diabetic retinopathy creening than mydriatic ophthalmocopy, the currently accepted creening method. When adjudicated by tandard even-field color photograph, the higher enitivity of digital photography primarily reflected the reduced enitivity of ophthalmocopy in detecting early retinopathy