Clinical Publications

MAESTRO

Evaluation of the Inclusion Of Spectral Domain Optical Coherence Tomography in a Telemedicine Diabetic Retinopathy Screening Program: A Real Clinical Practice

AUTHORS:

Arruabarrena C, Rodríguez-Miguel A, Allendes G, Vera C, Son B, Teus MA

PUBLICATION:

Retina. 2023 Aug 1;43(8):1308-1316. doi: 10.1097/IAE.0000000000003832.

Study Purpose

To evaluate whether combining spectral domain optical coherence tomography (SD-OCT) with monoscopic fundus photography using a nonmydriatic camera (MFP-NMC) improves the accuracy of diabetic macular edema (DME) referrals in a teleophthalmology diabetic retinopathy screening program

Overview

Study Design

Cross-sectional study

# of Eyes/
Patients

3,819 eyes of 1,925 patients with diabetes (Type I or II)

Study Device

Topcon 3D OCT-1 Maestro: 3-field MFP-NMC centered on macula, disc, and superior–temporal, and a 6×6 macula raster OCT scan

Outcome Measures

Prevalence of DME using different diagnostic criteria defined for MFP-NMC and SD-OCT, diagnostic accuracy of DME when SD-OCT was added to a retinography based teleophthalmology DR screening program

Results

The prevalence of DME in MFP-NMC was found to be 1.52%, 1.83%, and 1.22% according to English National Screening Program (ENSP), Scotland National Screening Program (SNSP), and central hard exudates criteria, respectively
Using SD-OCT, the prevalence of DME was 1.75% for center involved diabetic macular edema, 8.77% had a macular volume of >8 mm3, 8.45% showed foveal or parafoveal thickening, and 1.54% had foveal or parafoveal thickening with anatomical signs of DME
Sensitivity barely reached 50% in MFP-NMC and less for the quantitative criteria of spectral domain optical coherence tomography
When macular thickening and anatomical signs of DME were considered for the OCT criterion, sensitivity increased to 88.3% with a 99.8% specificity, and the false DMEs and non-gradable images were reduced

IMOvifa reduced measurement time by

39%

Conclusions

• Incorporation of SD-OCT into MFP-NMC using an all-in-one device within a well-established diabetic screening program improved the diagnostic accuracy of DME. • Macular thickening and anatomical signs showed the highest suitability for screening, with a sensitivity of 88.3% and a specificity of 99.8%. Notably, MFP-NMC alone missed half of the true DMEs that lacked indirect signs.