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Diabetes Care 30:e47 2007
DOI: 10.2337/dc07-0052
© 2007 by the American Diabetes Association
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Online Letters: Comments and Responses

The Sensitivity and Specificity of Nonmydriatic Digital Stereoscopic Retinal Imaging in Detecting Diabetic Retinopathy

Response to Ahmed et al.

Rajiv Raman, MS, DNB, Padmaja Kumari Rani, MS, FNB and Tarun Sharma, MS, FRCS ED

From Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India

Address correspondence to Dr. Tarun Sharma, MD, FRCS Ed, Director, Shri Bhagwan Mahavir Vitreoretinal services, Sankara Nethralaya, College Road, Chennai, 600 006, Tamil Nadu, India. E-mail: drtaruns{at}gmail.com

Ahmed et al. (1) concluded that nonmydriatic digital stereoscopic retinal imaging is a sensitive and specific method for the screening and diagnosis of diabetic retinopathy that may help improve compliance with the standards of eye care for patients with diabetes. This strategy seems to be a good option in a country like India, where the ophthalmologist-to-population ratio is estimated to be nearly 1:100,000 (2,3). The ratio is close to 1 per 219,000 in rural areas (4), and 70% of the ophthalmologists are located in urban areas, where ~23% of the population of India resides. According to a report by the American Academy of Ophthalmology (5), single-field fundus photography can serve as a screening tool for diabetic retinopathy to identify patients with retinopathy for referral.

We compared single-field 45° nonmydriatic photographs centered on macula and single-field 45° mydriatic photographs with dilated fundus evaluation by a retinal specialist in 135 eyes of 68 diabetic patients who attended two diabetic retinopathy screening camps in the rural areas of Thiruvanamalai, district of Tamilnadu. The images were converted to DICOM (Digital Imaging and Communications in Medicine) format by picture archival and communication software (PACS; Vipro Infotech, Germany) and transferred to the hub at a tertiary eye care base hospital at Chennai, Tamilnadu, by satellite link using very small aperture terminal hardware with a transmission rate of 384 kb/s. Another retinal specialist sitting in the hub evaluated all of the images in real time using a Sony videoconferencing system.

In our study, the nonmydriatic technique of photography was found to have a sensitivity of 62.5% (95% CI 24–91) and a specificity of 98.7% (93–99) when compared with indirect ophthalmoscope. The mydriatic technique of photography had a sensitivity of 70% (35–93) and a specificity of 98% (93–99) when compared with indirect ophthalmoscope. By using three nonsimultaneous 45° field stereoscopic fundus images, as described by Ahmed et al. (5), we can expect an improvement in the sensitivity of the nonmydriatic technique. Thus, three-field nonmydriatic fundus images transmitted via satellite can be a good alternative in a country like India, where health care facilities and personnel are scarce compared with patient load.

References

  1. Ahmed J, Ward TP, Bursell SE, Aiello LM, Cavallerano JD, Vigersky RA: The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy. Diabetes Care 29:2205–2209, 2006[Abstract/Free Full Text]
  2. Kumar R: Ophthalmic manpower in India: need for a serious review. Int Ophthalmol 17:269–275, 1993[Medline]
  3. Rao GN: Ophthalmology in India. Arch Ophthalmol 118:1431–1432, 2000[Free Full Text]
  4. Bhaduri G, Banerjea A: Blindness: the Indian scenario and plans to combat. J Indian Med Assoc 94:401–402, 1996[Medline]
  5. Williams GA, Scott IU, Haller JA, Maguire AM, Marcus D, McDonald HR: Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology. Ophthalmology 111:1055–1062, 2004[Medline]

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
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Google Scholar
Right arrow Articles by Raman, R.
Right arrow Articles by Sharma, T.
Right arrow Search for Related Content
PubMed
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Right arrow Articles by Sharma, T.
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