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

Abstract 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.