Potential Efficiency Benefits of Nonmydriatic Ultrawide Field Retinal Imaging in an Ocular Telehealth Diabetic Retinopathy Program

  1. Lloyd Paul Aiello, MD PhD1,2
  1. 1Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
  3. 3New England College of Optometry, Boston, Massachusetts, USA
  4. 4Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
  1. Corresponding author: Paolo S. Silva, Email: paoloantonio.silva{at}


Objective: To compare efficiency of nonmydriatic ultrawide field retinal imaging(UWFI) and nonmydriatic fundus photography(NMFP) in a diabetic retinopathy(DR) ocular telehealth program

Research Design and Methods: Retrospective, comparative cohort study of patients imaged from 11/01/2011-11/01/2012. Images were evaluated for DR and diabetic macular edema(DME) using standard protocol at a centralized reading center with certified graders. Identification of DR, image evaluation time and rate of ungradable eyes were compared.

Results: 1,633 and 2,170 consecutive patients were imaged using NMFP and UWFI, respectively. There were no statistically significant differences between groups in age, diabetes duration, gender, ethnicity or insulin use. The ungradable rate per patient for DR(2.9% vs 9.9%,p<0.0001) and DME(3.8% vs 8.8%,p<0.0001) was lower with UWFI than NMFP. With UWFI, median image evaluation time per patient was reduced from 12.8 to 9.2 minutes(p<0.0001). The identification of patients with DR(38.4% vs 33.8%) and vision-threatening DR(14.5% vs 11.9%) was increased with UWFI vs NMFP. In a consecutive subgroup of 502 eyes of 301 patients with DR, the distribution of peripheral retinal lesions outside ETDRS fields might have suggested a more severe DR level in 9.0%(45 eyes).

Conclusions: In a standardized DR ocular telehealth program, nonmydriatic UWFI reduced the ungradable rate by 71% (to less than 3%) and reduced image evaluation time by 28%. DR was identified 17% more frequently after UWFI was implemented and DR peripheral lesions may have suggested a more severe DR level in 9%. These data suggest that UWF imaging may improve efficiency of ocular telehealth programs evaluating DR and DME.

  • Received May 30, 2013.
  • Accepted August 6, 2013.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.

This Article

  1. Diabetes Care
  1. All Versions of this Article:
    1. dc13-1292v1
    2. 37/1/50 most recent