R Lm Wong1,2,3, C W Tsang1,3, D Sh Wong2, S McGhee4, C H Lam2, J Lian4, J Wy Lee2, J Sm Lai2, V Chong2,5, I Yh Wong2. 1. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong. 2. Department of Ophthalmology, The University of Hong Kong, Pokfulam, Hong Kong. 3. Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong. 4. Department of Community Medicine, The University of Hong Kong, Pokfulam, Hong Kong. 5. Oxford Eye Hospital, Oxford University Hospitals, Oxford, United Kingdom.
Abstract
INTRODUCTION: A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan. METHODS: This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy. RESULTS: A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%. CONCLUSION: The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.
INTRODUCTION: A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan. METHODS: This was a cross-sectional observational study. Consecutive diabeticpatients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 μm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 μm was used to assess the false-positive rate of this screening strategy. RESULTS: A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 μm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 μm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 μm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%. CONCLUSION: The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.
Authors: Ou Tan; Aiyin Chen; Yan Li; Steven Bailey; Thomas S Hwang; Andreas K Lauer; Michael F Chiang; David Huang Journal: Exp Biol Med (Maywood) Date: 2021-09-15
Authors: Ru-Ik Chee; Dana Darwish; Alvaro Fernandez-Vega; Samir Patel; Karyn Jonas; Susan Ostmo; J Peter Campbell; Michael F Chiang; Rv Paul Chan Journal: Curr Ophthalmol Rep Date: 2018-01-29
Authors: Fangyao Tang; Xi Wang; An-Ran Ran; Carmen K M Chan; Mary Ho; Wilson Yip; Alvin L Young; Jerry Lok; Simon Szeto; Jason Chan; Fanny Yip; Raymond Wong; Ziqi Tang; Dawei Yang; Danny S Ng; Li Jia Chen; Marten Brelén; Victor Chu; Kenneth Li; Tracy H T Lai; Gavin S Tan; Daniel S W Ting; Haifan Huang; Haoyu Chen; Jacey Hongjie Ma; Shibo Tang; Theodore Leng; Schahrouz Kakavand; Suria S Mannil; Robert T Chang; Gerald Liew; Bamini Gopinath; Timothy Y Y Lai; Chi Pui Pang; Peter H Scanlon; Tien Yin Wong; Clement C Tham; Hao Chen; Pheng-Ann Heng; Carol Y Cheung Journal: Diabetes Care Date: 2021-07-27 Impact factor: 17.152
Authors: Yuchen Xie; Dinesh V Gunasekeran; Konstantinos Balaskas; Pearse A Keane; Dawn A Sim; Lucas M Bachmann; Carl Macrae; Daniel S W Ting Journal: Transl Vis Sci Technol Date: 2020-04-13 Impact factor: 3.283
Authors: Paolo Lanzetta; Valentina Sarao; Peter H Scanlon; Jane Barratt; Massimo Porta; Francesco Bandello; Anat Loewenstein Journal: Acta Diabetol Date: 2020-03-28 Impact factor: 4.280
Authors: Andreas Ochs; Stuart McGurnaghan; Mike W Black; Graham P Leese; Sam Philip; Naveed Sattar; Caroline Styles; Sarah H Wild; Paul M McKeigue; Helen M Colhoun Journal: PLoS Med Date: 2019-10-17 Impact factor: 11.069