Purpose To evaluate digital colour photography and oral fluorescein angiography (OFA) for diabetic retinopathy screening. Methods Thirty-seven patients were selected from either a diabetic retinopathy screening or a medical retina clinic. Three 45° colour digital images and a single macula 45° OFA image were taken from each eye. Standard seven- field stereo photography with ETDRS grading was used as a gold standard for data comparison. The images were assessed by two graders and the results of each method compared using the McNemar test. Results Five eyes had no diabetic retinopathy, 50 had background diabetic retinopathy, 3 had pre-proliferative diabetic retinopathy, 11 had proliferative disease and 3 had quiescent post- treatment disease. Clinically significant macular oedema was present in 25 eyes and absent in 48. For grading diabetic retinopathy digital colour photography produced a sensitivity of 0.87 (specificity 0.83); OFA produced a sensitivity of 0.87 (specificity 0.80) (p = 0.1). For the detection of diabetic maculopathy, the sensitivity of digital colour photography was 0.48 (specificity of 0.95) and for OFA was 0.87 (specificity 0.87) (p < 0.01). Conclusion This pilot study has shown that both digital colour photography and OFA compare well with conventional methods for diabetic retinopathy screening. The results encourage the further evaluation of OFA in the screening for diabetic maculopathy.
American Academy of Ophthalmology, American Medical Association, American Diabetic Association. Guidelines for screening for diabetic retinopathy. Ann Intern Med 1992;116:683–5
A protocol for screening for diabetic retinopathy in Europe. Retinopathy Working Party. Diabet Med 1991;8 (3):263–7.
Burns-Cox J . Prevention of blindness: a lost opportunity [editorial]. J Med Screening 1996;3:169.
Kohner EM, Porta M . Protocols for screening and treatment of diabetic retinopathy in Europe. Eur J Ophthalmol 1991;1:45–54
Javitt JC, Aiello LP, Chiang Y, Ferris FL 3rd, Canner JK, Greenfield S . Preventive eye care in people with diabetes is cost-saving to the federal government: implications for health-care reform. Diabetes Care 1994;17:909–17
Kalm H, Egertsen R, Blohme G . Non-stereo fundus photography as a screening procedure for diabetic retinopathy among patients with type II diabetes: compared with 60 D enhanced slit-lamp examination. Acta Ophthalmol (Copenh) 1989;67:546–53
Cathelineau G, Cathelineau BV . Diabetic retinopathy: methodologies in practice [review]. Diabet Med 1991;8:S17–22.
Davies R, Sullivan P, Canning C . Simulation of diabetic eye disease to compare screening policies. Br J Ophthalmol 1996;80:945–50
Gardner GG, Keating D, Williamson TH, Elliott AT . Automatic detection of diabetic retinopathy using an artificial neural network: a screening tool [see comments]. Br J Ophthalmol 1996;80:940–4
Undrill P . Towards the interpretation of retinal images. Br J OphthalmoI 1996;80:937–8
Diabetes Control and Complications Trial Research Group. Color photography versus fluorescein angiography in the diabetes control trial. Arch Ophthalmol 1987;105:1344–51
Noble MJ, Cheng H, Jacobs PM . Oral fluorescein and cystoid macular oedema: detection in aphakic and pseudophakic eyes. Br J Ophthalmol 1984;68:221–4
Nayak BK, Ghose S . A method for fundus evaluation in children with oral fluorescein. Br J Ophthalmol 1987;71:907–9
Morgan KS, Franklin RM . Oral fluorescein angioscopy in aphakic children. J Pediatr Ophthalmol Strabismus 1984;21:33–6
Kelley JS, Kincaid M, Hoover RE, McBeth C . Retinal fluorograms using oral fluorescein. Ophthalmology 1980;87:805–11
Kinsella FP, Mooney DJ . Anaphylaxis following oral fluorescein angiography. Am J Ophthalmol 1988;106:745–6
Gomez-Ulla F, Malvar A, Parafita M, Polo P, Seoane I . Oral fluorescein angiography and fluoroscopy: determination of plasma fluorescein levels and clinical application. Optometry Vis Sci 1992;69:986–90
Ghose S, Nayak BK . Role of oral fluorescein in the diagnOSiS of early papilloedema in children. Br J Ophthalmol 1987;71:910–5
Early Treatment Diabetic Retinopathy Study Group. A modification of the Airlie House classification of diabetic retinopathy. Diabetic Retinopathy Study Report no. 7. Invest Ophthalmol Vis Sci 1981;21:210.
Moss S, Meuer S, Klein R, Hubbard L, Brothers R, Klein B . Are seven standard photographic fields necessary for classification of diabetic retinopathy? Invest Ophthalmol Vis Sci 1989:30:823–8.
Harding SP, Broadbent DM, Neoh C, White MC, Vora J . Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study [see comments]. BMJ 1995;311:1131–5
Leese GP, Newton RW, Jung RT, Haining W, Ellingford A . Screening for diabetic retinopathy in a widely spaced population using non-mydriatic fundus photography in a mobile unit. Tayside Mobile Eye Screening Unit. Diabet Med 1992;9:459–62
Kerr D, Cavan DA, Jennings B, Dunnington C, Gold D, Crick M . Beyond retinal screening: digital imaging in the assessment and follow up of patients with diabetic retinopathy. Diabet Med 1998;15:878–82
Early Treatment for Diabetic Retinopathy Study Group. Study 1. Photocoagulation for diabetic macular oedema. Arch Ophthalmol 1985;103:1796–806
Klein R, Klein B, Neider M, Hubbard L, Meuer S, Brothers R . Diabetic retinopathy as detected using ophthalmoscopy, a nonmydriatic camera and a standard fundus camera. Ophthalmology 1985;92:485–91
Ryder R, Young S, Vora J, Atiea J, Owens J, et al . Screening for diabetic retinopathy using poloroid retinal photography through undilated pupils. Practical Diabetes 1985;2:34–9
About this article
Cite this article
Newsom, R., Moate, B. & Casswell, T. Screening for diabetic retinopathy using digital colour photography and oral fluorescein angiography. Eye 14, 579–582 (2000). https://doi.org/10.1038/eye.2000.146
- words Diabetic retinopathy
- Digital photography
- Oral fluorescein angiography
This article is cited by
Current Diabetes Reports (2016)
Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography
Comparison of optometry vs digital photography screening for diabetic retinopathy in a single district
Assessing diabetic retinopathy using two-field digital photography and the influence of JPEG-compression
Documenta Ophthalmologica (2004)