Integrating Macular Optical Coherence Tomography with Ultrawide Field Imaging in a Diabetic Retinopathy Telemedicine Program Using a Single Device

• Published in: Retina (Philadelphia, Pa.)
• Main Authors: Aiello, Lloyd Paul, Jacoba, Cris Martin P, Ashraf, Mohamed, Cavallerano, Jerry D, Tolson, Ann M, Tolls, Dot, Sun, Jennifer K, Silva, Paolo S
• Format: Journal Article
• Language: English
• Published: United States 01.11.2023
• ISSN: 1539-2864
• DOI: 10.1097/IAE.0000000000003883

To determine the effect of combined macular optical coherence tomography (SD-OCT) and ultrawide field retinal imaging (UWFI) within a telemedicine program. Comparative cohort study of consecutive patients with both UWFI and SD-OCT. UWFI and SD-OOCT were independently evaluated for diabetic macular edema (DME) and non-diabetic macular pathology. Sensitivity and specificity were calculated with SD-OCT as gold standard. 422 eyes from 211 diabetic patients were evaluated. DME severity by UWFI: no DME 93.4%, non-center involved DME (nonciDME) 5.1%, ciDME 0.7%, ungradable DME 0.7%. SD-OCT was ungradable in 0.5%. Macular pathology was identified in 34 (8.1%) eyes by UWFI and in 44 (10.4%) eyes by SD-OCT. DME represented only 38.6% of referable macular pathology identified by SD-OCT imaging. Sensitivity/specificity of UWFI compared to SD-OCT was 59%/96% for DME and 33%/99% for ciDME. Sensitivity/specificity of UWFI compared to SDOCT was 3%/98% for ERM. Addition of SD-OCT increased the identification of macular pathology by 29.4%. Over 58.3% of the eyes thought to have any DME on UWF imaging alone were false positives by SD-OCT. The integration of SD-OCT with UWFI markedly increased detection and reduced false positive assessments of DME and macular pathology in a teleophthalmology program.