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An evaluation of fundus photography and fundus autofluorescence in the diagnosis of cuticular drusen
  1. Tracy B Høeg1,2,
  2. Birgitte Moldow1,
  3. Ronald Klein3,
  4. Morten La Cour2,4,
  5. Kristian Klemp4,
  6. Ditte Erngaard1,
  7. Christina Ellervik2,5,
  8. Helena Buch4
  1. 1Department of Ophthalmology, Næstved Hospital, Næstved, Denmark
  2. 2The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
  4. 4Department of Ophthalmology, Capital Region Eye Clinic, Glostrup, Denmark
  5. 5Department of General Population Study, Nykøbing-Falster Hospital, Nykøbing Falster, Denmark
  1. Correspondence to Dr Tracy Beth Høeg, Department of Ophthalmology, Ringstedgade 61, Næstved 4700, Denmark; tracybethhoeg{at}


Purpose To examine non-mydriatic fundus photography (FP) and fundus autofluorescence (FAF) as alternative non-invasive imaging modalities to fluorescein angiography (FA) in the detection of cuticular drusen (CD).

Methods Among 2953 adults from the Danish Rural Eye Study (DRES) with gradable FP, three study groups were selected: (1) All those with suspected CD without age-related macular degeneration (AMD) on FP, (2) all those with suspected CD with AMD on FP and (3) a randomly selected group with early AMD. Groups 1, 2 and 3 underwent FA and FAF and group 4 underwent FAF only as part of DRES CD substudy. Main outcome measures included percentage of correct positive and correct negative diagnoses, Cohen's κ and prevalence-adjusted and bias-adjusted κ (PABAK) coefficients of test and grader reliability.

Results CD was correctly identified on FP 88.9% of the time and correctly identified as not being present 83.3% of the time. CD was correctly identified on FAF 62.0% of the time and correctly identified as not being present 100.0% of the time. Compared with FA, FP has a PABAK of 0.75 (0.60 to 1.5) and FAF a PABAK of 0.44 (0.23 to 0.95).

Conclusions FP is a promising, non-invasive substitute for FA in the diagnosis of CD. FAF was less reliable than FP to detect CD.

  • Diagnostic tests/Investigation
  • Imaging
  • Retina

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