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@#AIM:To observe and analyze the effect of non-mydriatic fundus photography in screening diabetic retinopathy(DR), so as to provide the basis for clinical screening.<p>METHODS:In our hospital from December 2016 to November 2017, 120 patients(240 eyes)was diagnosed as diabetes(DM), which were treated as the subjects of observation. By the same operator with non-mydriatic fundus photography, fundus photography and 7 range fundus fluorescein angiography(FFA)after mydriasis were taken. Taking the international clinical classification of diabetic retinopathy(DR)as the standard, the above three examinations were review, grade and record by the same physician by blind method. The fundus fluorescein angiography as the gold standard, the other two results were compared to detect the sensitivity, specificity, Youden index, Kappa value of the two for DR with different grade.<p>RESULTS: There was 70.0% eyes diagnosed as diabetic retinopathy after screened by fundus angiography, 66.7% by post-mydriatic fundus photography, 65.0% by non-mydriatic fundus photography. The grading results of diabetic retinopathy screened by different methods were basically consistent, with no significant difference(<i>P</i>>0.05). When screening for diabetic retinopathy of different degrees, the sensitivity and specificity of the non-mydriatic group were 92.9% and 90.3%, respectively. There was no significant difference between the results of the non-mydriatic group and the non-mydriatic group. Compared with the gold standard group(FFA), the Youden index(83.14%)was close to 1, with high reliability; Kappa=0.81, and the validation was consistent. When screening for moderately nonproliferative diabetic retinopathy, the sensitivity and specificity of non-mydriatic fundus photography were 90.6% and 95.5%; there was no significant difference between the results of non-mydriatic and the results of fundus photography after mydriasis. Compared to the gold standard group, the Youden index was 86.09%, the reliability is high, Kappa=0.86, and the test was consistency. <p>CONCLUSION:Non-mydriatic fundus photography can be used as a simple and accurate method for screening diabetic retinopathy. It is simple and easy to carry out without risk. It is easy to train specialist technicians for multi-point operation. With the help of today's convenient network, the image is transmitted to an experienced ophthalmologist for reading and diagnosis, which is convenient and fast, so that the patient can be diagnosed and treated nearby, which has positive significance for the society.
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@#AIM:To observe the clinical value of digital nonmydriatic funds photography in screening diabetic retinopathy and early intervention of hospitalized diabetic patients. <p>METHODS: Totally 130 diabetic patients hospitalized in Department of Endocrinology of our hospital were selected from January 2015 to December 2016. All patients were underwent non-mydriatic digital fundus photography and fundus fluorescein angiography(FFA). <p>RESULTS: There were 82 eyes diagnosed as non-proliferative diabetic retinopathy(NPDR)and 28 eyes as proliferative diabetic retinopathy(PDR)by non-mydriatic digital fundus photography. There were 89 eyes diagnosed as NPDR and 29 eyes as PDR by FFA. Compared with the result of the gold standard, the Kappa value of non-mydriatic digital fundus photography was 0.87(>0.61), and the test was consistency. There was no significant difference between the two methods in the detection of diabetic retinopathy in different stages(<i>P</i>>0.05). The positive rate of diabetic retinopathy was significantly higher in patients with diabetes mellitus over 10a(<i>P</i><0.05). <p>CONCLUSION: Digital fundus photography is an effective method for early detection of DR in hospitalized diabetic patients. It is of great significance to reduce the blindness rate of diabetic retinopathy.
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PURPOSE: To clarify the relationship between various factors (sociodemographic factors, health behavioral risk factors and health status, and diabetic factors) related to diabetic retinopathy and to suggest improvements regarding the associated medical examination. METHODS: The subjects were 1,444 diabetic patients diagnosed in the 5th Korean National Health and Nutrition Examination Survey (KNHANES), aged 19 years or older, who underwent non-mydriatic fundus photography. The criteria for diagnosing diabetes were a fasting glucose level ≥ 126 mg/dL and a previous diagnosis of diabetes or currently undergoing treatment. The diagnosis of diabetic retinopathy followed the modified Airlie House classification. Univariate and multivariate analyses of diabetic retinopathy were performed. RESULTS: Among the 1,444 patients who were diagnosed with diabetes, 277 had diabetic retinopathy; the prevalence rate was 19.18%. The higher the body mass index, the lower the risk of diabetic retinopathy by 0.924 times (p = 0.001; 95% confidence interval [CI], 0.883–0.966). The longer the duration of diabetes, the greater the risk of diabetic retinopathy; the prevalence period group of more than 11 years had a 26.025-fold higher risk than the newly diagnosed group (p < 0.001; 95% CI, 10.840–62.482). The risk of diabetic retinopathy increased with the hemoglobin A1c (HbA1c) level; the risk was 5.973-fold higher in the group with HbA1c above 11.0% (p < 0.001; 95% CI, 2.984–11.956) compared with the group with HbA1c < 6.0%. The risk of diabetic retinopathy was 2.050-fold greater with insulin injections (p = 0.003; 95% CI, 1.284–3.275). CONCLUSIONS: The risk of diabetic retinopathy was higher in patients with a longer duration of diabetes, a high HbA1c level, and in those using insulin. These findings highlight the need for early education and ophthalmologic examinations for at-risk patients.
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Humans , Body Mass Index , Classification , Diabetic Retinopathy , Diagnosis , Education , Fasting , Glucose , Health Behavior , Insulin , Multivariate Analysis , Nutrition Surveys , Photography , Prevalence , Risk FactorsABSTRACT
[Objective]To evaluate the practicality of non-mydriatic digital fundus camera in the remote screen of diabetic retinopathy for community residents.[Methods]Ninety-two patients(184 eyes)with type 2 diabetes mellitus have been taken 1-field and 5-field non-mydriatic fundus photography and examination in mydriatic fundus by pre-placed-mirror ophthalmoscopy by a ophthalmologist,the results were sent to the hospital with a computer programs. A specialist evaluates the consistency of detectable rate of diabetic retinophathy(DR)among the 3 methods.The time of tak-ing 1-field and 5-field non-mydriatic fundus photography is compared.[Results]All the three methods show good consis-tency in detectable rate of DR compare with each other,the κ value is 0.89 for 1-field non-mydriatic fundus photography and examination in mydriatic fundus by preplaced-mirror ophthalmoscopy,0.95 for 1-field and 5-field non-mydriatic fundus photography and 0.95 for 5-field non-mydriatic fundus photography and examination in mydriatic fundus by pre-placed-mirror ophthalmoscopy,respectively. The 1-field non-mydriatic fundus photography spent less time compares with 5-field non-mydriatic fundus photography(55.4±5.8 vs 405.9±68.5 s,P<0.01).[Conclusion]The remote screen for diabetic retinopathy in community based on non-mydriatic digital fundus camera is worth promoting,we suggest 1-field non-mydriatic fundus photography as a screen method.
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To investigate the utility of optomap panoramic 200Tx in screening fundus disease among the patients after cataract surgery. ●METHODS: From November 18 th to December 31st , 2013 all 146 post- cataract surgery patients were recruited. All non - mydriatic fundus images were taken with the optomap panoramic 200Tx and were diagnosed by one masked retinal specialist. Non - mydriatic direct ophthalmoscope exam and mydriatic slit-lamp lens exam were also done by other two masked specialists. Comparisons of the three methods were made. ●RESULTS: Among 146 patients ( 161 eyes), 40 eyes (24. 8%) of retinal lesions was detected by non-mydriatic direct ophthalmoscope exam, 59 ( 36. 7%) by non -mydriatic optomap 200Tx exam, and 61 (37. 9%) by slit-lamp lens exam. Nine eyes ( 5. 6%) needed medical intervention immediately. Results of optomap 200Tx exams and slit - lamp lens exams were similar without statistically significant difference ( P > 0. 05), better than direct ophthalmoscope exam ( P ● CONCLUSlON: Opacification of the refractive medium makes thorough fundus examination impossible. So post-operative fundus examination is highly necessary and should be a routine. Optomap panoramic 200Tx, which shows no statistically difference from mydriatc slit- lamp lens exam, is a convenient and feasible method in discovering fundus pathological changes.
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AIM:To observe the incidence of ocular fundus disease in preschool children examined by non-mydriatic fundus camera and evaluate its effectiveness compared with direct inspection shadow mirror. METHODS: Three thousand eight hundred and ninety-six preschool children from April 2012 to October 2013 were examined by Topcon TRC-NW300 color fluorescence fundus camera and direct inspection shadow mirror, and images were saved immediately. RESULTS: Detection rate of non - mydriatic fundus photography was higher than that of direct inspection shadow mirror. In 3 896 cases, 41 eyes were detected abnormal fundus accounting for 1. 05%. The retinal myelinated nerve fibers, morning glory syndrome, retinitis pigmentosa, congenital retinoschisis were common, accounted for 24. 39%, 21. 95%, 14. 63%, 12-20% respectively. The children eye diseases were often accompanied by abnormal vision (68. 30%), ametropia (63. 41%), strabismus (19. 51%). CONCLUSION:Non-mydriatic fundus photography is a mydriatic method without medicine, so it is easy for preschool children to accept. Image results could directly display the fundus lesions. It shows important significance in the screening for preschool children eye diseases.
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PURPOSE: To evaluate the efficacy of a single field, non-mydriatic, 45degrees digital photography as a diagnostic tool for diabetic retinopathy. METHODS: A total of 303 consecutive diabetic patients (606 eyes) who underwent digital fundus photography and indirect ophthalmoscopy were included in the present study. The optical discs and macular area of all patients were subjected to single fundus photography using a non-mydriatic 45-degree digital fundus camera. All patients also underwent fundus examinations after pupil dilation via indirect ophthalmoscopy. RESULTS: The sensitivity and specificity for determining diabetic retinopathy were 47.6% and 97.6%, respectively. The false positive rate, false negative rate, positive predictive value, and negative predictive values were 2.3%, 2.1%, 45.5%, and 97.8%, respectively. Among the digital fundus images, 12.9% (78 eyes) were non-gradable. The patients with non-gradable digital fundus images were older (p < 0.001), had a longer duration of diabetes, (p < 0.001) and more often suffered from systemic hypertension (p = 0.003) compared to patients with gradable photographs. CONCLUSIONS: The present study showed that single-field, non-mydriatic, 45 degree digital photography for detecting diabetic retinopathy had relatively low sensitivity and high technical failure rates. The failure rates could be improved with higher resolution non-mydriatic wide-field photography cameras and with additional peripheral images for diabetic retinopathy screening.
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Humans , Diabetic Retinopathy , Hypertension , Mass Screening , Ophthalmoscopy , Photography , Pupil , Sensitivity and SpecificityABSTRACT
PURPOSE: To investigate the usefulness of the non-mydriatic digital fundus camera for detection of normal-tension glaucoma in routine health check-ups. METHODS: Among 1986 persons who received a routine health check-up in the Kangnam Health Care Center of Seoul National University Hospital (SNUH) from October to December 2003, 60 patients were referred to the Glaucoma Clinic of SNUH due to a suspicious optic nerve head or a retinal nerve fiber layer (RNFL) defect detected by a non-mydriatic digital fundus camera. The glaucoma work-up was performed, including Goldmann applanation tonometry, red free RNFL photography, Humphrey visual field (HVF), Stratus OCT and HRT II. RESULTS: Among 60 patients with a suspicious optic nerve head or suspected RNFL defect, 23 patients showed a retinal nerve fiber layer defect on red free RNFL photography. Those 23 patients had already demonstrated possible RNFL defects on photographs taken by a non-mydriatic digital fundus camera at their routine health check-up. In comparison with the normal, high PSD value of HVF (p=0.002), the narrow neuroretinal rim area shown by OCT (p=0.05) and HRT (p=0.02) were significantly different statistically. CONCLUSIONS: The non-mydriatic digital fundus camera can serve as a useful tool to screen normal-tension glaucoma in routine health check-up systems. However, the final diagnosis of glaucoma should be confirmed by red free RNFL photography and standard automated perimetry.
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Humans , Delivery of Health Care , Diagnosis , Glaucoma , Manometry , Nerve Fibers , Optic Disk , Optic Nerve , Photography , Retinaldehyde , Seoul , Visual Field Tests , Visual FieldsABSTRACT
PURPOSE: To evaluate the efficiency of digital retinal nerve fiber layer (RNFL) photographs converted from a non-mydriatic digital fundus camera for detecting RNFL defects. METHODS: Ninety-five eyes were evaluated with both a non-mydriatic digital fundus photograph and a digital RNFL photograph by two glaucoma specialists independently. The red-free, monochrome modified digital fundus photograph was acquired from non-mydriatic digital fundus photographs using Photoshop 7.0. Whether a localized wedge-shaped or diffuse RNFL defect existed or not was evaluated on a non-mydriatic digital fundus photograph and a modified digital fundus photograph, and inter- and intraobserver agreement were also evaluated. Regarding the use of digital RNFL photographs as a standard method, we calculated the sensitivity, specificity, and positive and negative predictive values of the two types of photographs. RESULTS Interobserver agreement (Cohen's kappa values) about localized RNFL defects observable on digital RNFL photographs, non-mydriatic digital fundus photographs, and modified digital fundus photographs were 0.749, 0.634, and 0.793, respectively, but all were 0.417 or less with regard to diffuse RNFL defects. Regarding localized RNFL defects, the sensitivity, specificity, and positive and negative predictive values of modified digital fundus photographs were 85.7%, 95.5%, 85.7% and 94.1%, respectively, showing superiority to those of non-mydriatic digital fundus photographs. But, in cases of diffuse RNFL defect, the sensitivity and specificity of modified digital fundus photographs were 60.0% and 97.8%, respectively, indicating no superiority to non-mydriatic digital fundus photographs. CONCLUSIONS: The localized RNFL defect can be detected more efficiently with modified digital fundus photographs than non-mydriatic digital fundus photographs, but the diffuse RNFL defect cannot.
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Glaucoma , Nerve Fibers , Retinaldehyde , Sensitivity and Specificity , SpecializationABSTRACT
PURPOSE: To evaluate the efficiency of digital retinal nerve fiber layer (RNFL) photographs converted from a non-mydriatic digital fundus camera for detecting RNFL defects. METHODS: Ninety-five eyes were evaluated with both a non-mydriatic digital fundus photograph and a digital RNFL photograph by two glaucoma specialists independently. The red-free, monochrome modified digital fundus photograph was acquired from non-mydriatic digital fundus photographs using Photoshop 7.0. Whether a localized wedge-shaped or diffuse RNFL defect existed or not was evaluated on a non-mydriatic digital fundus photograph and a modified digital fundus photograph, and inter- and intraobserver agreement were also evaluated. Regarding the use of digital RNFL photographs as a standard method, we calculated the sensitivity, specificity, and positive and negative predictive values of the two types of photographs. RESULTS Interobserver agreement (Cohen's kappa values) about localized RNFL defects observable on digital RNFL photographs, non-mydriatic digital fundus photographs, and modified digital fundus photographs were 0.749, 0.634, and 0.793, respectively, but all were 0.417 or less with regard to diffuse RNFL defects. Regarding localized RNFL defects, the sensitivity, specificity, and positive and negative predictive values of modified digital fundus photographs were 85.7%, 95.5%, 85.7% and 94.1%, respectively, showing superiority to those of non-mydriatic digital fundus photographs. But, in cases of diffuse RNFL defect, the sensitivity and specificity of modified digital fundus photographs were 60.0% and 97.8%, respectively, indicating no superiority to non-mydriatic digital fundus photographs. CONCLUSIONS: The localized RNFL defect can be detected more efficiently with modified digital fundus photographs than non-mydriatic digital fundus photographs, but the diffuse RNFL defect cannot.
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Glaucoma , Nerve Fibers , Retinaldehyde , Sensitivity and Specificity , SpecializationABSTRACT
Photography of slit-lamp biomicroscopy combined with retro-illumination photography is the gold standard in cataract evaluation. However the application is limited due to its complexity and low efficiency. We introduce digital non-mydriatic fundus photography as a new method for cataract screening in patients with visual impairment,which might play an important role in screening low vision and blindness caused by cataract. Two distinguished benefits are found in this method including compatibility for tele-diagnosis,and integration with screening of glaucoma and diabetic retinopathy. Cautions should be made on the photographs in which media opacity derived from other than cataract or low quality photos due to small pupils.