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  • Title: A comparison between one- and two-field 60 degree fundus photography when screening for diabetic retinopathy.
    Author: von Wendt G, Rönnholm P, Heikkilä K, Summanen P.
    Journal: Acta Ophthalmol Scand; 2000 Feb; 78(1):14-20. PubMed ID: 10726781.
    Abstract:
    PURPOSE: To compare the severity level of diabetic retinopathy obtained when assessed from two versus only one 60 degrees photographic field using colour transparencies and red-free, black-and-white photographs. To compare the areal coverage of these two photographic strategies to that of seven-field 30 degrees photography. METHODS: Two ophthalmologists graded photographs of 74 eyes of 74 type I and II diabetes patients. Inter-method agreement was expressed in percentages and using kappa statistics and scatter-diagrams. The comparison of the approximate photographic areal coverage was done from diagrams using planimetry. RESULTS: The severity level of retinopathy when judged from two photographic fields was more severe in 13.5% (Grader 1) and in 16.2% (Grader 2) from colour transparencies and in 13.5% (Grader 1) and in 14.9% (Grader 2) from red-free black-and-white prints, as compared to assessments from only one field. Kappa values (0.84-0.86) for inter-method agreement for five pooled retinopathy levels revealed good agreement. Neither grader missed retinopathy requiring clinical assessment or treatment (levels > or = 47) when minimal retinopathy (levels 14-20) was detected using only one 60 degrees colour slide or red-free photograph. A second optic disc-centred field provided valuable additional information when more severe retinopathy lesions (levels > or = 30) were detected in the macula-centred field. One macula-centred 60 degrees photograph covered 60% and two 60 degrees photographs 80% of the area covered by seven-field 30 degrees photography. Two-field 60 degrees photography covers areas left outside seven-field 30 degrees photography. CONCLUSION: We propose the use of one macula-centred 60 degrees photograph when screening for the first lesions of diabetic retinopathy. After they have been found two-field 60 degrees photography is recommended.
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