The Retinal Disease Screening Study: Retrospective Comparison of Nonmydriatic Fundus Photography and Three-Dimensional Optical Coherence Tomography for Detection of Retinal Irregularities

PURPOSE. To determine the sensitivity of three-dimensional optical coherence tomography (3D-OCT) versus single field nonmydriatic fundus photography (FP) for detection of a variety of retinal abnormalities. METHODS. Images from consecutive patients in a retina clinic undergoing simultaneous 3D-OCT (5123128) and single, foveal nonmydriatic 45 degrees color fundus imaging with 3D-OCT-1000 in a 4 month-period were retrospectively collected. Findings from each modality were graded independently by two graders as present, questionable, or absent. Irregularities were separated into three categories for intermodality comparisons: epiretinal, retinal/subretinal, and RPE/choroidal irregularities. The approximate location of findings in relation to the 3D-OCT field was noted as in field and out of field. Findings from both modalities were combined to form the gold standard for comparison for each modality. RESULTS. Five hundred and one sets of 3D-OCT scans and fundus images of 395 eyes of 223 patients were found in the study period, of which, 474 unique visits were included. Ninety-six percent of the scans had abnormal findings. Twenty-six fundus images (5.5%) were ungradable. 3D-OCT identified some abnormality in 25/26 (96.2%) of the ungradable fundus images. For overall detection of a variety of retinal irregularities or irregularity of each category (epiretinal, intraretinal, or RPE/choroidal irregularity), 3D-OCT was found to be more sensitive than that of nonmydriatic color fundus images. When single specific feature was speculated, 3D-OCT demonstrated various detection abilities: higher than FP for abnormal retinal thickness (or intraretinal hyporeflective features); similar as FP for RPE atrophy; however, lower for pigment migration (or intraretinal hemorrhage). CONCLUSIONS. In this study, sensitivities of 3D-OCT were higher than nonmydriatic fundus images for overall detection of retinal abnormalities or irregularities in each category. 3D-OCT demonstrated good ability to detect most features; however, with limitation to intraretinal hemorrhage and pigment migration. It is likely that OCT will be added to photography screening for chorioretinal diseases in the near future.