How accurate are photographic surrogate markers used to detect macular edema in the English national screening programme?

H.M. Wharton, J.M. Gibson, P.M. Dodson

Research output: Contribution to journalMeeting abstract

Abstract

DESIGN. Retrospective analysis
PURPOSE. Macular oedema is not directly visible on two dimensional digital photographs such that surrogate markers need to be used. In the English National Screening Programme these are exudate within one optic disc diameter (DD) of the fovea, group of exudates within two DD of the fovea and haemorrhages or microaneurysms (HMA) within one DD of the fovea with best corrected visual acuity (VA) worse than 6/9. All patients who present with any of these surrogate markers at screening are referred to an ophthalmology clinic for slit lamp examination. The purpose of this audit was to determine how many patients with positive maculopathy diagnosis on photography were truly identified by optical coherence tomography (OCT) with macular oedema.
METHODS. Data was collected from patients attending digital diabetic retinopathy screening. Patients who presented with surrogate markers for macular oedema also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present.
RESULTS. Maculopathy by exudates: Of 155 patients 45 (29%) showed thickening on the OCT of these 12 required laser. Those who also had pre-proliferative retinopathy (n=20) were more likely to have macular oedema (75%) than those with background diabetic retinopathy.
Maculopathy by HMA and VA worse than 6/9: Of 66 patients 11 (16.7%) showed thickening on the OCT. 5 (7.6%) of these had macular oedema, 5 (7.6%) epi-retinal membrane, and 1 (1.5%) age related macular degeneration. None of these patients required laser.
CONCLUSIONS. The likelihood of the presence of macular oedema and requiring laser treatment is greater with macular exudation than HMA within one DD and reduced VA. Overall the surrogate markers used show low specificity for macular oedema, however combining OCT with photography does identify those with macular oedema who require a true referral for an ophthalmological slit lamp examination.
Original languageEnglish
Pages (from-to)348
Number of pages1
JournalEuropean Journal of Ophthalmology
Volume21
Issue number3
Publication statusPublished - 15 Apr 2011
Event21st Meeting of the European Association for the Study of Diabetes Eye Complications Study Group (EASDec) - Gdansk, Poland
Duration: 13 May 201115 May 2011

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Macular Edema
Biomarkers
Optical Coherence Tomography
Exudates and Transudates
Visual Acuity
Lasers
Photography
Diabetic Retinopathy
Hemorrhage
Optic Disk
Ophthalmology
Referral and Consultation
Membranes

Bibliographical note

Abstracts of the 21st Meeting of the European Association for the Study of Diabetes Eye Complications Study Group (EASDEc)

Cite this

@article{a9d712a33ea648aa9e9d41c78637e76c,
title = "How accurate are photographic surrogate markers used to detect macular edema in the English national screening programme?",
abstract = "DESIGN. Retrospective analysisPURPOSE. Macular oedema is not directly visible on two dimensional digital photographs such that surrogate markers need to be used. In the English National Screening Programme these are exudate within one optic disc diameter (DD) of the fovea, group of exudates within two DD of the fovea and haemorrhages or microaneurysms (HMA) within one DD of the fovea with best corrected visual acuity (VA) worse than 6/9. All patients who present with any of these surrogate markers at screening are referred to an ophthalmology clinic for slit lamp examination. The purpose of this audit was to determine how many patients with positive maculopathy diagnosis on photography were truly identified by optical coherence tomography (OCT) with macular oedema.METHODS. Data was collected from patients attending digital diabetic retinopathy screening. Patients who presented with surrogate markers for macular oedema also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present.RESULTS. Maculopathy by exudates: Of 155 patients 45 (29{\%}) showed thickening on the OCT of these 12 required laser. Those who also had pre-proliferative retinopathy (n=20) were more likely to have macular oedema (75{\%}) than those with background diabetic retinopathy.Maculopathy by HMA and VA worse than 6/9: Of 66 patients 11 (16.7{\%}) showed thickening on the OCT. 5 (7.6{\%}) of these had macular oedema, 5 (7.6{\%}) epi-retinal membrane, and 1 (1.5{\%}) age related macular degeneration. None of these patients required laser.CONCLUSIONS. The likelihood of the presence of macular oedema and requiring laser treatment is greater with macular exudation than HMA within one DD and reduced VA. Overall the surrogate markers used show low specificity for macular oedema, however combining OCT with photography does identify those with macular oedema who require a true referral for an ophthalmological slit lamp examination.",
author = "H.M. Wharton and J.M. Gibson and P.M. Dodson",
note = "Abstracts of the 21st Meeting of the European Association for the Study of Diabetes Eye Complications Study Group (EASDEc)",
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language = "English",
volume = "21",
pages = "348",
journal = "European Journal of Ophthalmology",
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How accurate are photographic surrogate markers used to detect macular edema in the English national screening programme? / Wharton, H.M.; Gibson, J.M.; Dodson, P.M.

In: European Journal of Ophthalmology, Vol. 21, No. 3, 15.04.2011, p. 348.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - How accurate are photographic surrogate markers used to detect macular edema in the English national screening programme?

AU - Wharton, H.M.

AU - Gibson, J.M.

AU - Dodson, P.M.

N1 - Abstracts of the 21st Meeting of the European Association for the Study of Diabetes Eye Complications Study Group (EASDEc)

PY - 2011/4/15

Y1 - 2011/4/15

N2 - DESIGN. Retrospective analysisPURPOSE. Macular oedema is not directly visible on two dimensional digital photographs such that surrogate markers need to be used. In the English National Screening Programme these are exudate within one optic disc diameter (DD) of the fovea, group of exudates within two DD of the fovea and haemorrhages or microaneurysms (HMA) within one DD of the fovea with best corrected visual acuity (VA) worse than 6/9. All patients who present with any of these surrogate markers at screening are referred to an ophthalmology clinic for slit lamp examination. The purpose of this audit was to determine how many patients with positive maculopathy diagnosis on photography were truly identified by optical coherence tomography (OCT) with macular oedema.METHODS. Data was collected from patients attending digital diabetic retinopathy screening. Patients who presented with surrogate markers for macular oedema also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present.RESULTS. Maculopathy by exudates: Of 155 patients 45 (29%) showed thickening on the OCT of these 12 required laser. Those who also had pre-proliferative retinopathy (n=20) were more likely to have macular oedema (75%) than those with background diabetic retinopathy.Maculopathy by HMA and VA worse than 6/9: Of 66 patients 11 (16.7%) showed thickening on the OCT. 5 (7.6%) of these had macular oedema, 5 (7.6%) epi-retinal membrane, and 1 (1.5%) age related macular degeneration. None of these patients required laser.CONCLUSIONS. The likelihood of the presence of macular oedema and requiring laser treatment is greater with macular exudation than HMA within one DD and reduced VA. Overall the surrogate markers used show low specificity for macular oedema, however combining OCT with photography does identify those with macular oedema who require a true referral for an ophthalmological slit lamp examination.

AB - DESIGN. Retrospective analysisPURPOSE. Macular oedema is not directly visible on two dimensional digital photographs such that surrogate markers need to be used. In the English National Screening Programme these are exudate within one optic disc diameter (DD) of the fovea, group of exudates within two DD of the fovea and haemorrhages or microaneurysms (HMA) within one DD of the fovea with best corrected visual acuity (VA) worse than 6/9. All patients who present with any of these surrogate markers at screening are referred to an ophthalmology clinic for slit lamp examination. The purpose of this audit was to determine how many patients with positive maculopathy diagnosis on photography were truly identified by optical coherence tomography (OCT) with macular oedema.METHODS. Data was collected from patients attending digital diabetic retinopathy screening. Patients who presented with surrogate markers for macular oedema also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present.RESULTS. Maculopathy by exudates: Of 155 patients 45 (29%) showed thickening on the OCT of these 12 required laser. Those who also had pre-proliferative retinopathy (n=20) were more likely to have macular oedema (75%) than those with background diabetic retinopathy.Maculopathy by HMA and VA worse than 6/9: Of 66 patients 11 (16.7%) showed thickening on the OCT. 5 (7.6%) of these had macular oedema, 5 (7.6%) epi-retinal membrane, and 1 (1.5%) age related macular degeneration. None of these patients required laser.CONCLUSIONS. The likelihood of the presence of macular oedema and requiring laser treatment is greater with macular exudation than HMA within one DD and reduced VA. Overall the surrogate markers used show low specificity for macular oedema, however combining OCT with photography does identify those with macular oedema who require a true referral for an ophthalmological slit lamp examination.

UR - https://journals.sagepub.com/doi/10.5301/EJO.2011.6363

M3 - Meeting abstract

VL - 21

SP - 348

JO - European Journal of Ophthalmology

JF - European Journal of Ophthalmology

SN - 1120-6721

IS - 3

ER -