What is it about?

Aims: To investigate the evaluation indices (diagnostic test accuracy and agreement) of 15 combinations of ultrawide field scanning laser ophthalmoscopy (UWF SLO) images in myopic retinal changes (MRC) screening to determine the combination of imaging that yields the highest evaluation indices in screening MRC. Methods: This is a retrospective study of UWF SLO images obtained from myopes and were analyzed by two retinal specialists independently. 5-field UWF SLO images that included the posterior (B), superior (S), inferior (I), nasal (N) and temporal (T) regions were obtained for analysis and its results used as a reference standard. The evaluation indices of different combinations comprising of one to four fields of the retina were compared to determine the abilities of each combinations screen for MRC. Results: UWF SLO images obtained from 823 myopic patients (1646 eyes) were included for the study. Sensitivities ranged from 50.0% to 98.9% (95% confidence interval (CI), 43.8-99.7%); the combinations of B+S+I (97.3%; 95% CI, 94.4-98.8%), B+T+S+I (98.5%; 95% CI, 95.9-99.5%), and B+S+N+I (98.9%; 95% CI, 96.4-99.7%) ranked highest. Furthermore, the combinations of B+S+I, B+T+S+I and B+S+N+I also revealed the highest accuracy (97.7%; 95% CI, 95.1-100.0%, 98.6%; 95% CI, 96.7-100.0%, 98.8%; 95% CI, 96.9-100.0%) and agreement (Kappa = 0.968, 0.980 and 0.980). For the various combinations, specificities were all higher than 99.5% (95% CI, 99.3-100.0%). Conclusion: In our study, screening combinations of B+S+I, B+T+S+I and B+S+N+I stand out with high-performing optimal evaluation indices. However, when time is limited, B+S+I may be more applicable in primary screening of MRC.

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Why is it important?

The UWF SLO is widely used as an auxiliary tool to screen for myopic retinal changes, a steered imaging method, therefore, is needed to screen these lesions. While 5-field UWF SLO images are able to provide the assistant basis for diagnosis, treatment, and recording of peripheral myopic retinal changes, B+S+I, B+T+S+I or B+S+N+I are also efficient and comprehensive methods in screening for peripheral myopic retinal changes. Out of which, the B+S+I approach involves a simple clinical operation and has high efficiency, meaning low time and energy consumption while yielding high sensitivity, specificity, accuracy and agreement, and is therefore the clinically optimal combination we recommend for efficient screening of peripheral myopic retinal changes.


In clinical practice, in order to perform a complete screening and diagnosis of the patient's retina, the UWF SLO images of the fundus are usually collected in 5-field including the basic posterior pole (B), superior (S), inferior (I), nasal (N) and temporal (T) sides. However, this method often leads to long examination and waiting time. Repeated attempts due to poor cooperation of some patients also causes discomfort in patients. Therefore, this study explored that there is a screening method that with similar sensitivity and specificity as the standard 5-field UWF SLO image even if the number of acquisition field is reduced. Furthermore, the reduced fields of acquisition should also aim to have similar screening effect as the standard 5-field.

Xuan Deng

Read the Original

This page is a summary of: Myopic retinal changes screening: comparison of sensitivity and specificity among 15 combinations of ultrawide field scanning laser ophthalmoscopy images, Ophthalmic Research, January 2021, Karger Publishers,
DOI: 10.1159/000514176.
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