Enhancing Nonmydriatic Color Photographs of the Retina With Monochromatic Views and a Stereo Pair to Detect Diabetic Retinopathy

Background and Objective: Nonmydriatic digital color imaging is rapidly gaining an important role in screening for diabetic retinopathy. However, it has yet to equal a dilated fundus examination or seven Early Treatment Diabetic Retinopathy Study field 35-mm photography. The authors therefore attempted to enhance efficacy and validity by adding two low-cost steps to the nonmydriatic digital image evaluation. Patients and Methods: The fundi of 145 consecutive patients with diabetes mellitus were evaluated for diabetic retinopathy using two different nonmydriatic reading techniques: creating a red-free view (using digital filters) and looking at a stereo pair of each field taken. These methods were each compared to a mydriatic fundus examination. Results: Although the first technique yielded views with sensitivities and specificities similar to what exists in the literature using this same technique, enhancing these photographs (second technique) yielded a statistically significant increase in sensitivity and specificity ( P < .005). Conclusion: The authors recommend using both low-cost steps when screening for diabetic retinopathy through nonmydriatic digital color imaging. [Ophthalmic Surg Lasers Imaging 2009;40:373–378.]