[Performance of ultra-wide field retinophotography for screening of diabetic retinopathy]. / Performance de la rétinophotographie en ultra-grand champ dans le dépistage de la rétinopathie diabétique.

INTRODUCTION: Early diagnosis of diabetic retinopathy is a public health issue. Fundus retinophotography (FRP) is widely used for the detection of the disease. Recently, ultra-wide field retinophotography (WFRP) device allows imaging of approximately 80% of the retinal surface in a single image. The goal of the present study was to evaluate the efficacy of WFRP in the diagnosis and gradation of diabetic retinopathy compared to the gold standard of FRP. METHODS: The non-mydriatic Optos P200Tx was used for WFRP imaging. FRP in the 9 positions of gaze was then acquired with the Topcon TRC-NW6S after pupillary dilation. The processing time for each imaging modality was recorded. RESULTS: One hundred and sixteen eyes of 58 patients were included in this study. Fourteen eyes were excluded from the analysis due to insufficient imaging quality. WFRP sensitivity was 96% and specificity was 92%. Only 6 eyes received a higher severity grade of diabetic retinopathy by WFRP compared to FRP. In these cases, when the WFRP was analyzed in the same field as the FRP, the severity grade was similar for 5 of the 6 eyes. The mean time of acquisition was significantly lower for WFRP compared to FRP. CONCLUSION: WFRP is fast and effective in screening for diabetic retinopathy. The severity grade of the disease was similar to the gold standard of FRP in most cases. WFRP could thus be used in mass screening for diabetic retinopathy.

Detection of mild papilloedema using spectral domain optical coherence tomography.

OBJECTIVE: To propose a method of diagnosis of mild papilloedema (PO) using peripapillary total retinal (PTR) thickness measurement by spectral domain optical coherence tomography (OCT). METHODS: 24 eyes in 24 patients with PO caused by increased intracranial pressure and 22 eyes in 22 normal subjects were studied. OCT high-quality fundus images were analysed and graded by three masked observers using the Modified Frisén Scale. Eyes with PO were divided into two subgroups: those with mild PO (n=18) and those with moderate-severe PO (n=6). Two methods of measurements were evaluated and compared: retinal nerve fibre layer (RNFL) thickness measurements using standard optic disc cube 200 × 200 acquisition protocol and PTR thickness measurements using the 'macular' cube 512 × 128 acquisition protocol centred on the optic disc. Thickness values were calculated globally and for each quadrant (temporal, superior, nasal, inferior) and compared among the three groups (control, mild PO, moderate-severe PO). The main outcome measures were RNFL and PTR thickness. RESULTS: Average RNFL and PTR thickness in the moderate-severe PO, mild PO and control groups were 299.3 ± 10.9, 112.4 ± 6.3, 96 ± 5.7 and 804.5 ± 17, 463.1 ± 9.8 and 332.4 ± 8.9 µm, respectively. Moderate-severe PO differed from mild PO and control groups using both RNLF thicknesses and PTR thicknesses measurements. Mild PO did not differ from controls using RNLF thickness measurement (p=0.17), but was statistically different using PTR thickness measurement (p<0.001). CONCLUSION: PTR thickness measurement increases the sensitivity of detection of mild PO compared with conventional RNFL measurement. This new way of using OCT may be useful for clinicians to detect mild PO.