Evaluation of digital fundus images as a diagnostic method for surveillance of diabetic retinopathy

Abstract

Objective: The goal was to evaluate a digital imaging system for diagnosing and grading diabetic retinopathy (DR) and cystoid macular edema (CME). Methods: A single 45°, nonmydriatic, digital color photograph was taken of 231 eyes of 120 patients with diabetes mellitus. The images were graded for DR and CME by a remote ophthalmologist, and the results were compared with dilated ophthalmoscopy performed by a retina spe-cialist. Results: For DR, the level of agreement between digital image review and ophthalmoscopy was moderate (κ = 0.44). The sensitivity and specificity of digital image review were 0.60 and 1.00, respectively. For CME, the level of agreement was moderate (κ = 0.60). The sensitivity and specificity of digital image review were 0.60 and 0.99, respectively. Conclusion: A single 45°, nonmydriatic, digital image is not reliable as the sole modality for DR screening. However, with modifications, it may be useful where access to an experienced ophthalmologist is limited.