High-resolution stereoscopic digital fundus photography versus contact lens biomicroscopy for the detection of clinically significant macular edema

Abstract

Purpose The purpose of this study was to compare high-resolution stereoscopic digital photography to contact lens biomicroscopy (CLBM) for the diagnosis of clinically significant macular edema. Study design Comparative, prospective, observational case series. Participants One hundred twenty diabetic patients. Methods Patients underwent clinical retinal examination with CLBM by a retinal specialist. On the same day as clinical grading, patients received high-resolution stereoscopic digital imaging of the macula. The stereoscopic digital images were viewed using liquid crystal shutter goggles at least 2 months after clinical examination by a single masked grader for the presence or absence of diabetic retinopathy. Main outcome measures Presence or absence of the Early Treatment of Diabetic Retinopathy Study criteria for clinically significant macular edema (CSME) overall, CSME 1, CSME 2, CSME 3, macular edema, microaneurysms, intraretinal hemorrhage, and hard exudate. Results Two hundred seven eyes of 105 patients had complete data sets from both diagnostic modalities. Exact agreement was high for all identified pathologic conditions: CSME overall, 83.6%; CSME 1, 83.6%; CSME 2, 96.1%; CSME 3, 88.5%; macular edema, 75.0%; microaneurysms, 77.9%; intraretinal hemorrhage, 83.7%; and hard exudate, 73.1%. Sensitivity ranged from 50.0% (CSME 2) to 90.6% (CSME overall). Specificity ranged from 90.0% (macular edema) to 99.0% (CSME 2). Conclusions High-resolution stereoscopic digital photography is both sensitive and specific when identifying CSME and correlates well with the accepted standard of CLBM for the diagnosis of CSME.