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Abstract #73533 Published in IGR 18-4

Glaucoma Screening in Nepal: Cup to Disc Estimate with Standard Mydriatic Fundus Camera Compared to Portable Non-mydriatic Camera

PURPOSE: To compare cup to disc ratio (CDR) measurements from images taken with a portable, 45° non-mydriatic fundus camera to images from a traditional table-top mydriatic fundus camera. DESIGN: Prospective, cross sectional, comparative instrument validation study. METHODS: materials-methods SETTING: Clinic-based. STUDY POPULATION: 422 eyes of 211 subjects were recruited from the Tilganga Institute of Ophthalmology (Kathmandu, Nepal). Two masked readers measured CDR and noted possible evidence of glaucoma (CDR ≥0.7 or the presence of a notch or disc hemorrhage) from fundus photographs taken with a non-mydriatic portable camera and a mydriatic standard camera. Each image was graded twice. MAIN OUTCOME MEASURES: Effect of camera modality on CDR measurement, inter- and intra-observer agreement for each camera for the diagnosis of glaucoma. RESULTS: 196 eyes (46.5%) were diagnosed with glaucoma by chart review. 41.2%-59.0% of eyes were remotely diagnosed with glaucoma over grader, repeat measurement, and camera modality. There was no significant difference in CDR measurement between cameras after adjusting for grader and measurement order (estimate=0.004, 95% confidence interval (CI), 0.003-0.011, p=0.24). There was moderate inter-observer reliability for the diagnosis of glaucoma (Pictor (κ=0.54, CI, 0.46-0.61); Topcon (κ=0.63, CI, 0.55-0.70) and moderate intra-observer agreement upon repeat grading (Pictor (κ=0.63 and 0.64, for Graders 1 and 2, respectively); Topcon (κ=0.72 and 0.80, for Graders 1 and 2, respectively). CONCLUSIONS: A portable, non-mydriatic, fundus camera can facilitate remote evaluation of disc images on par with standard mydriatic fundus photography.

School of Public Health, University of Michigan, Ann Arbor, MI, USA.

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