Comparison among 15 combinations of myopic retinal changes screening.

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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Photo by v2osk on Unsplash

Photo by v2osk on Unsplash

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.

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