Elsevier

Ophthalmology

Volume 111, Issue 4, April 2004, Pages 712-715
Ophthalmology

Original article
Comparison of the clinical diagnosis of diabetic macular edema with diagnosis by optical coherence tomography

Presented at: American Academy of Ophthalmology Annual Meeting, November, 2003; Anaheim, California.
https://doi.org/10.1016/j.ophtha.2003.06.028Get rights and content

Abstract

Purpose

To compare the diagnosis of diabetic macular edema (DME) by stereoscopic slit-lamp biomicroscopic examination of the fundus with a 78-diopter noncontact lens with diagnosis by optical coherence tomography (OCT).

Design

Prospective, double-masked, noninterventional diagnostic study.

Methods

Analysis of slit-lamp biomicroscopic findings compared with OCT measurements.

Participants

Patients with DME from a private retina practice.

Main outcome measures

Presence or absence of macular thickening.

Results

The reference range for this clinic was comparable to reference ranges published from other clinics. The clinical detection of DME was less than detection by OCT. Chance-corrected agreements (κ statistic) of the 2 methods were 0.63 for the foveal zone and 0.36 to 0.42 for the 4 parafoveal zones. The errors committed in clinical examination were primarily of the type in which clinical examination did not detect DME but OCT did (58%–90%) for the 5 zones analyzed.

Conclusions

Reference ranges for OCT seem to be similar for different clinical settings, suggesting the usefulness of OCT in multicenter studies. The current standard of care for DME detection, stereoscopic slit-lamp examination of the fundus, is less sensitive than OCT for detection of DME. Because the principal therapy for DME, focal laser photocoagulation, is mainly sight preserving and not sight restoring, the wider use of OCT may beneficially impact visual disability from DME.

Section snippets

Materials and methods

Eighty patients having 143 eyes with clinically significant DME as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) seen in a private retina practice were examined first by the physician and then by one of 2 certified ophthalmic photographers experienced in performing OCT. The clinical determination of DME was made by stereoscopic slit-lamp biomicroscopy using a noncontact 78-diopter (D) fundus lens. Although Goldmann contact lens biomicroscopy was the clinical examination

Results

The reference range for normal values of OCT scans is shown in Table 1. For comparison, the values for the patients with DME are listed in Table 2. For all 5 regions, the distributions of values in the patients with DME were shifted toward higher values (P values ranging from 0.0363 to 0.0005).

A sample 2×2 table comparing clinical and OCT assessments of retinal thickening is shown for the foveal zone (Table 3), as well as the method of calculation of the statistics quantitating agreement

Discussion

The reference range of values for the different zones obtained with OCT in this study are similar to those reported in other studies.2, 4 This suggests that OCT values between different settings are comparable, which is important information for planners of multicenter studies.

It is commonly recognized that the clinical assessment of DME is subjective and variable.2, 6 In the DRS and ETDRS, stereoscopic fundus photographs graded by technicians masked to clinical information were compared with

Cited by (0)

Manuscript no. 230054.

The authors have no proprietary interest in any of the materials used in this study.

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