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Comparison of Opthalmoscopy, Fundus Photography, Fundus Autofluorescence, and OCT-Angiography in Detection of Retinal Pathology in a Clinical Population

May 2020


Purpose: To investigate the efficacy of detecting ocular abnormalities between live fundus exams and fundus photography, fundus autofluorescence, and OCT angiography.

Methods: A total of one hundred subjects (200 eyes) were recruited during comprehensive dilated eye exams at the Forest Grove Eye Clinic. Exclusion criteria included subjects under 18 years of age and those unable to complete a dilated eye exam. Subjects were imaged with fundus autofluorescence (FAF), OCT-angiography (OCTA), and color fundus photography after completing a dilated fundus examination. Images were de-identified and evaluated by two optometrists not involved with the clinical exam. Collaborative data from the graders and DFE data collected from a retrospective chart review by an independent party were compiled and analyzed.

Results: Fundus photography and FAF detected higher quantity of clinical findings than identified in DFE. OCTA had the least observed retinal irregularities but also the highest incomplete data. With DFE as the reference standard, sensitivity was highest in FAF (93%) and fundus photo (86%) but lowest in OCTA (30%). Specificity was highest in OCTA (93%). All three instruments had positive predictive values (PPV) less than 40%. When observing for retinal pigment epithelial lesions, specificity (98%) and PPV (92%) were better with DFE but sensitivity (92%) and NPV (98%) were higher with FAF. Utilizing a ground truth, FAF (100%) and fundus photography (82%) had the high sensitivity when observing for more clinically relevant findings. DFE (79%) was found to have the highest PPV.

Conclusions: FAF, fundus photos, and OCTA served an important role in an eye care setting. Fundus photography and FAF identified more retinal findings than observed in DFE, however the PPV in all imaging modalities were low when compared to DFE. When compared to the ground truth, DFE performed better than imaging with the highest PPV. Although each of these techniques has its unique advantages and serve a complimentary role in an eye exam, this study did not that show that Imaging was more effective than DFE. However, imaging is an accessible tool for those unable to receive a DFE.


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