Imager evaluation of diabetic retinopathy at the time of imaging in a telemedicine program.

OBJECTIVE: To evaluate the ability of certified retinal imagers to identify presence versus absence of sight-threatening diabetic retinopathy (stDR) (moderate nonproliferative diabetic retinopathy or worse or diabetic macular edema) at the time of retinal imaging in a telemedicine program. RESEARCH DESIGN AND METHODS: Diabetic patients in a primary care setting or specialty diabetes clinic received Joslin Vision Network protocol retinal imaging as part of their care. Trained nonphysician imagers graded the presence versus absence of stDR at the time of imaging. These gradings were compared with masked gradings of certified readers. RESULTS: Of 158 patients (316 eyes) imaged, all cases of stDR (42 eyes [13%]) were identified by the imagers at the time of imaging. Six eyes with mild nonproliferative diabetic retinopathy were graded by the imagers to have stDR (sensitivity 1.00, 95% CI 0.90-1.00; specificity 0.97, 0.94-0.99). CONCLUSIONS: Appropriately trained imagers can accurately identify stDR at the time of imaging.

Effects of dilation on electronic-ETDRS visual acuity in diabetic patients.

PURPOSE: To evaluate the effect of pupillary dilation on electronic-ETDRS visual acuity (EVA) in diabetic subjects and to assess postdilation EVA as a surrogate for predilation VA. METHODS: DRCR.net-protocol refraction and EVA were measured before and after dilation in diabetic subjects by independent, masked examiners. RESULTS: In 129 eyes of 66 subjects, the median (25th, 75th percentiles) predilation EVA score was 69 (54, 86) (Snellen-equivalent 20/40(-1) [20/80(-1), 20/20(+1)]). Predilation VA was >or=20/20, <20/20 to 20/40, <20/40 to 20/80, and <20/80 in 29%, 19%, 26%, and 26% of eyes, respectively. Median EVA change postdilation was -3 letters (-7, 0). The absolute change in EVA score was >or=15 letters (>or=3 ETDRS lines) in 9% of eyes and >or=10 letters (>or=2 ETDRS lines) in 19% of eyes. Extent of change (range +12 to -25 letters) was associated with baseline VA. No relationship was identified between EVA change and gender, race, lens status, refractive error, DR severity, or primary cause of vision loss. CONCLUSIONS: In an optimized clinical trial setting, there is a decline in best corrected EVA after dilation in diabetic subjects. The large range and magnitude of VA change preclude using postdilation EVA as a surrogate for undilated VA.