Comparison of dilated fundus examinations with seven-field stereo fundus photographs in the Veterans Affairs Diabetes Trial

Journal of Diabetes and Its Complications
Nicholas EmanueleVADT Study Group

Abstract

The Veterans Affairs Diabetes Trial (VADT) is a 20-medical center, prospective, randomized study of 1792 Type 2 diabetic individuals primarily aimed at determining whether intensive glycemic control prevents macrovascular events. We report a comparison of fundus photographs and ophthalmologic examination at baseline, permitting an evaluation of multiple settings similar to common clinical practice. A 340-patient subset had both local dilated fundus examinations and centrally read seven-field stereo fundus photographs completed within 60 days of each other (median 28 days). Local examiners were unaware of the stereo photographs. Overall, agreement within one step was 76% and exact agreement between ophthalmoscopy and central gradings of fundus photographs on a five-step retinopathy severity scale was 43% (weighted kappa 0.42, CI 0.35-0.48). In about 90% of disagreements the severity level was higher by photographic grading. The sensitivity for ophthalmoscopy compared to grading of fundus photographs for the detection of any retinopathy was 51% and specificity was 91%. For proliferative diabetic retinopathy (PDR), sensitivity was 61% and specificity 98%. Only one eye was high-risk PDR, and it was detected by both methods. For cli...Continue Reading

References

Nov 1, 1991·Diabetes Care·J WiekE Kohner
Sep 6, 2000·Diabetic Medicine : a Journal of the British Diabetic Association·A HutchinsonA Booth
Oct 30, 2003·Journal of Diabetes and Its Complications·Carlos AbrairaUNKNOWN VA Cooperative Study of Glycemic Control and Complications in Diabetes Mellitus Type 2
Jul 27, 2005·Diabetes Care·Nicholas EmanueleUNKNOWN Veterans Affairs Diabetes Trial Group

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Citations

Jul 21, 2011·Ocular Immunology and Inflammation·Sapna S GangaputraUNKNOWN MUST Trial Research Group
Dec 3, 2014·American Journal of Ophthalmology·Andrea RussoFrancesco Semeraro
Jun 9, 2017·The Cochrane Database of Systematic Reviews·Marinella RuospoGiovanni Fm Strippoli

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