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Novel utilisation of ultrawide-field fundus photography for detecting retinal nerve fibre layer defects in glaucomatous eyes
  1. Mi Jeung Kim1,2,
  2. Jung Hyun Lee1,
  3. Ji In Park3,
  4. Jin Young Choi1,2,
  5. Joonhong Sohn1,
  6. Ho Sik Hwang4,
  7. Daniel Duck-Jin Hwang1,2
  1. 1 Department of Ophthalmology, Hangil Eye Hospital, Incheon, Republic of Korea
  2. 2 Department of Ophthalmology, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
  3. 3 Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
  4. 4 Department of Ophthalmology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Professor Daniel Duck-Jin Hwang, Department of Ophthalmology, Hangil Eye Hospital, Incheon 21388, Republic of Korea; hallelu7{at}


Background/aims Evaluation of the retinal nerve fibre layer (RNFL) is important for identifying glaucomatous damage. Ultrawide-field fundus photography (UWP) imaging is increasingly used in the ophthalmological field; however, it is unknown whether it can be used for detecting RNFL defects (RNFLDs). We investigated whether RNFLD can be detected with UWP images and compared the clinical effectiveness of three types of images for detecting RNFLD: conventional red-free RNFL photography (RFP), non-mydriatic UWP and digitally converted green separation of non-mydriatic UWP (G-UWP).

Methods Eyes with glaucoma or glaucoma suspect and normal control eyes meeting the eligibility criteria were consecutively enrolled from September 2019 to April 2020. Their conventional RFP, non-mydriatic UWP and G-UWP images were assessed for detecting RNFLD to evaluate the sensitivity and specificity for detecting RNFLD.

Results Three image sets of 196 participants (84 normal control, 25 glaucoma suspect and 87 glaucoma) were obtained. The sensitivity of G-UWP (94.6%; 95% CI 88.7 to 98.0) and RFP (92.9%; 95% CI 86.4 to 96.9) was higher than that of UWP (82.1%; 95% CI 73.8 to 88.7; p<0.05). The sensitivities of G-UWP and RFP are comparable. The specificity of G-UWP (78.6%; 95% CI 68.3 to 86.8) and UWP (75.0%; 95% CI 64.4 to 83.8) was comparable, but both were lower than that of RFP (98.8%; 95% CI 93.5 to 100.0; p<0.05).

Conclusion Non-mydriatic UWP images can be used to detect RNFLD. Non-mydriatic G-UWP showed comparable sensitivity but lower specificity to conventional RFP. Non-mydriatic G-UWP could be used as a convenient and useful diagnostic tool for screening glaucoma in clinical settings.

  • glaucoma
  • diagnostic tests/investigation
  • imaging
  • retina

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • MJK and JHL contributed equally.

  • Contributors DDH and MJK were involved in the design of the study. DDH, MJK, JYC and JS were involved in the collection of data. DDH, MJK and JHL were responsible for the interpretation of the data. MJK, DDH, JHL, JIP and HSH were involved in manuscript writing. MJK and JHL contributed equally to this work as first authors.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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