Sensitivity and specificity of high-resolution wide field fundus imaging for detecting neovascular age-related macular degeneration.

Maiko Maruyama-Inoue,Shin Yamane,Arisa Ito,Shimpei Sato,Shaheeda Mohamed,Tatsuya Inoue,Kazuaki Kadonosono,Yoko Kitajima,Demetrios G Vavvas

doi:10.1371/journal.pone.0238072

Abstract

Early detection and treatment are important management strategies for neovascular age-related macular degeneration (AMD). The purpose of this study was to determine the sensitivity and specificity in detecting neovascular AMD using two wide-field imaging systems: ClarusTM (CLARUS 500™, Carl Zeiss Meditec AG, Jena, Germany) and Optos®(Optos California®, Optos PLC, Dunfermline, United Kingdom), compared to conventional digital fundus photographs. We retrospectively analyzed 109 eyes of 73 consecutive patients with neovascular AMD, who underwent standard examination and multimodal imaging, including fundus photography, and optical coherence tomography (OCT). Unmasked graders utilized slit-lamp biomicroscopy and OCT to diagnose neovascular AMD. Masked graders evaluated ClarusTM, Optos®, and digital fundus photograph methods to determine the presence of choroidal neovascularization associated with AMD. Sensitivity and specificity analyses were performed using combined fundoscopy and OCT as the reference standard. Ninety eyes were diagnosed with neovascular AMD and the remaining 19 eyes were normal based on the reference standard. Of these, neovascular AMD was detected using ClarusTM in 94.4% (85/90). The sensitivities of Optos® and digital fundus photographs were 81.1% (73/90) and 87.8% (79/90), respectively. The specificities using ClarusTM, Optos®, and digital fundus photographs were 89.5% (17/19), 94.7% (18/19), and 89.5% (17/19), respectively. ClarusTM, with its ability to image high-resolution wide field fundus, was considered superior for diagnosing neovascular AMD with high sensitivity and specificity. It may be a useful screening tool for early detection of neovascular AMD, facilitating prompt referral and treatment.

Highlights

Age-related macular degeneration (AMD) is the leading cause of severe irreversible vision loss in older adults in the United States and other developed countries [1, 2]
Ninety eyes were diagnosed with neovascular AMD and the remaining 19 eyes were normal based on the reference standard
The purpose of this study was to evaluate the accuracy of ClarusTM, Optos1, and digital fundus photographs for detecting neovascular AMD

Summary

Introduction

Age-related macular degeneration (AMD) is the leading cause of severe irreversible vision loss in older adults in the United States and other developed countries [1, 2]. Early detection and treatment initiation at onset of neovascular AMD results in better therapeutic outcomes [6]. In this regard, there are several fundus imaging systems available for screening. ClarusTM (CLARUS 500TM, Carl Zeiss Meditec AG, Jena, Germany) is a newly designed scanning laser ophthalmoscope that can obtain 133-degree field of the retina in a single image without mydriasis. Incorporated into this system are features of partially confocal optics and true color imaging using red, green, and blue laser ophthalmoscopy scans. The high-resolution of 7.3 microns and high image quality that avoids eyelash and eyelid artifacts enables diagnosis of a variety of lesions in the retina

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