Use of optomap for retinal screening within an eye casualty setting

Aim: To compare nurse-guided Optomap retinal imaging with examination by an eye casualty officer, in detecting clinically significant peripheral retinal lesions in patients with retinal symptoms. Methods: 219 patients presenting to eye casualty with retinal symptoms (flashing lights and floaters) were recruited. Retinal images were taken with the Optomap imaging system, and graded by an independent masked ophthalmologist. The findings from the Optomap and casualty officer were compared with a gold-standard examination with scleral indentation performed by a retinal specialist. We calculated the sensitivity and specificity of the Optomap and casualty officer. Results: The final analysis included 205 eyes of 187 patients. The sensitivity of the Optomap for detecting retinal detachment (n = 7) was 100% (95% CI 59-100%), the same as the casualty officer. For retinal holes/tears (n = 18) the Optomap sensitivity was 33% (13-59%), compared with 67% (41-87%) for the casualty officer. Combining all retinal lesions (n = 52), the sensitivity was 62% (47-75%) and 73% (59-84%), with specificity 96% (92-99%) and 98% (94-100%) for the Optomap and casualty officer respectively. Conclusion: The Optomap detects retinal detachments successfully but, due to limitations in the optics, is not able to accurately detect retinal holes and tears.