Evaluation of a combination digital retinal camera with spectral-domain optical coherence tomography (SD-OCT) that might be used for the screening of diabetic retinopathy with telemedicine: A pilot study.

AIMS: Pilot study to determine whether an instrument combining a non-mydriatic retinal camera and spectral domain optical coherence tomography (SD-OCT) is effective for screening patients with diabetic retinopathy (DR).

METHODS: Case series conducted between 2012 and 2013. DR imaged with a retinal camera/SD-OCT instrument viewed remotely was compared to a dilated examination by a retina specialist.

RESULTS: The combination instrument was better than the retina specialist in detecting more severe retinopathy, primarily because of the SD-OCT. For severe retinopathy (grade ≥ 3), the image grader had better sensitivity (87.3% [95% CI: 75.5%, 94.7%]) than the retina examiner (76.4% [95% CI: 63.0%, 86.8%]). Specificities were similar between the instrument grader (96.0% [95% CI: 86.3%, 99.5%]) and retina examiner (100.0% [95% CI: 92.9%, 100.0%]). When identifying diabetic macular edema (ME), the retina examiner only identified 47.6% (20/42) of eyes with ME detected by SD-OCT. The instrument was better than a dilated retinal examination in detecting ME and not as good at detecting mild or proliferative retinopathy.

CONCLUSIONS: As used in this study, the instrument was more effective in identifying DR than was the current recommendation of a dilated and comprehensive eye examination. SD-OCT is needed to accurately identify DR in a screening setting.