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

Lookup NU author(s): Vina Manjunath Manjunath, Dr Vasileios Papastavrou, Professor David SteelORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


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 metadata

Author(s): Manjunath V, Papastavrou V, Steel DHW, Menon G, Taylor R, Peto T, Talks J

Publication type: Article

Publication status: Published

Journal: Eye

Year: 2015

Volume: 29

Issue: 3

Pages: 416-423

Print publication date: 01/03/2015

Online publication date: 16/01/2015

Acceptance date: 30/11/2014

Date deposited: 11/04/2016

ISSN (print): 0950-222X

ISSN (electronic): 1476-5454

Publisher: Nature Publishing Group


DOI: 10.1038/eye.2014.320


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Funder referenceFunder name
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust
UCL Institute of Ophthalmology
PB-PG-0609-19117National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme