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Non-mydriatic ultrawide field scanning laser ophthalmoscopy compared with dilated fundal examination for assessment of diabetic retinopathy and diabetic macular oedema in Chinese individuals with diabetes mellitus
  1. Simon K H Szeto1,2,
  2. Raymond Wong1,2,
  3. Jerry Lok2,
  4. Fangyao Tang1,
  5. Zihan Sun1,
  6. Tiffany Tso1,
  7. Thomas C H Lam1,2,
  8. Clement C Tham1,2,
  9. Danny S Ng1,2,
  10. Carol Y Cheung1
  1. 1 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
  2. 2 Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
  1. Correspondence to Dr Carol Y Cheung, CUHK Eye Centre, Hong Kong Eye Hospital, Kln, Hong Kong, China; carolcheung{at}


Aims To evaluate the performance of ultrawide field scanning laser ophthalmoscopy (UWF-SLO) for assessing diabetic retinopathy (DR) and diabetic macular oedema (DME) in a Chinese population, compared with clinical examination.

Methods This is a retrospective cohort study. A series of 322 eyes from 164 patients with DM were included. Each patient underwent both dilated fundal examination with DR and DME grading by retina specialist and non-mydriatic 200° UWF-SLO (Daytona, Optos, Dunfermline, UK). The severity of DR and DME from UWF-SLO images was further graded by ophthalmologists, according to both international clinical DR and DME disease severity scales and the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Any DR, DME and vision-threatening DR (VTDR) were treated as endpoints for this study.

Results 23 out of 322 images (7.14%), including all four cases with proliferative DR on clinical examinations, were determined as ungradable. When the international scale was used for grading UWF-SLO images, the sensitivity of any DR, DME and VTDR was 67.7%, 67.4% and 72.6%, respectively; the specificity of any DR, DME and VTDR was 97.8%, 97.3% and 97.8%, respectively. The agreement with clinical grading in picking up any DR, DME and VTDR was substantial, with κ-values of 0.634, 0.694 and 0.707, respectively. The performance of UWF-SLO was shown to be lower when ETDRS scale was used for grading the images.

Conclusion The performance of non-mydriatic UWF-SLO is comparable in identifying DR with that of clinical examination in a Chinese cohort. However, whether UWF-SLO can be considered as tool for screening DR is still undetermined.

  • Imaging
  • Retina
  • Diagnostic tests/Investigation

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  • Contributors Conception and design: CYC and SKHS. Acquisition of data: RW, JL, FYT, ZS, DSN, TT. Analysis and interpretation of data: SKHS, FYT, ZS, TCHL. Drafting the article or revising it critically for important intellectual content: SKHS, CYC. Final approval of the version to be published: CYC, CCT. CYC is the guarantor of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Kowloon Central/East Research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.