Ultra-Widefield Imaging as a Teleophthalmology Screening Tool for Ocular Pathology

Abstract

Background

Prior studies have validated ultra-widefield imaging as a remote screening tool for diabetic retinopathy. The aim of this study was to determine its use in screening for any fundus pathology in a routine patient population.

Methods

In this prospective randomized study, patients underwent both slit lamp indirect ophthalmoscopy and ultra-widefield imaging. Ultra-widefield images were independently reviewed by two optometrists, and discrepancies were adjudicated by a retina specialist. Clinical findings from slit-lamp examiners and image-reviewers were coded into themes and clinically meaningful findings were extracted. Cohen’s kappa was used to estimate agreement for these findings between the two image-reviewers and between the image-reviewers and slit-lamp examiners.

Results

Nine-hundred eyes of 450 patients were examined and imaged, of which 616 eyes were analyzed. At least one abnormal fundus finding was present on ophthalmoscopy in 71 eyes (11%) and on adjudicated image interpretation in 166 eyes (27%). Agreement between the two image-reviewers was moderate to substantial for most clinically meaningful findings, including optic disc hemorrhage (κ = 0.8), macular exudates (κ = 0.7), and macular pigmentary changes (κ = 0.7). Agreement between examiners and image-reviewers was moderate to substantial for optic disc hemorrhage (κ = 1), indistinct optic disc margins (κ = 0.5), drusen (κ = 0.4), pigmentary changes (κ = 0.4), and hemorrhage (κ = 0.8). A total of 187 findings were detected by imaging but not examination, compared with 42 that were detected on examination but not imaging.

Conclusion

In a routine patient population, ultra-widefield imaging agreed with standard-of-care slit-lamp examinations and detected more fundus findings.

Keywords:

• ultra-widefield imaging
• teleophthalmology
• screening
• telehealth

Ethics Statement

The internal governance committee at Specsavers waived informed consent as only anonymized data were shared with UCSF. UCSF Institutional Review Board approval was not required as only anonymized data were analyzed.

Acknowledgments

We thank Dr. Josie Forte and Phil Gray at Specsavers for participant recruitment and data collection, and for sharing their expertise throughout the study.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Jay Stewart reports consulting fees for work unrelated to the present study from Carl Zeiss Meditec. The authors declare that they have no other conflicts of interest for this work.

Additional information

Funding

This is an unfunded study.