Comparison of clinical examination, fundus photography and optical coherence tomography findings in diabetic retinopathy screening

Purpose: To compare diabetic retinopathy (DR) findings of treatment-naive Diabetes Mellitus (DM) patients obtained with clinical examination, fundus fotography and optical coherence tomography (OCT) Methods: Two hundred and ninty two eyes 150 DR treatment-naive DM patients followed by our Endocrinology policlinic were included in our study. Patients were either on routine follow-up period or newly diagnosed. Complete ophthalmic examination was performed in each patient by a single examiner. Fundus photograph acquisition according to Early Treatment Diabetic Retinopathy Study (ETDRS) protocol and OCT were performed by an experienced technician. Acquired fundus photographs were evaluated by the same examinerwho is blinded to patients at the end of the study period. Results: According to stereoscopic fundus examination; 76 eyes (%26) showed no signs of DR, 76 eyes (%26) showed mild non-proliferative diabetic retinopathy (NPDR) signs, 44 eyes (%15,1) showed moderate NPDR signs, 78 eyes (%26,7) showed severe NPDR signs and 18 eyes (%6,2) showed proliferative diabetic retinopathy (PDR) signs. According to images acquired with ETDRS protocol; 79 eyes (%27,1) showed no signs DR, 81eyes (%27,7) showed mild NPDR signs, 50 eyes (%17,1) showed moderate NPDR signs, 68 eyes (%23,3) showed severe NPDR signs and 14 eyes (%4,8) showed PDR signs. According to Field 2 image acquired with ETDRS protocol; 98 eyes (%33,5) showed no signs DR, 84 eyes (%28,8) showed mild NPDR signs, 52 eyes (%17,8) showed moderate NPDR signs, 48 eyes (%16,4) showed severe NPDR signs and 10 eyes (%3,4) showed PDR signs. Diabetic macular edema was present in 106 and 100 eyes according to OCT and clinical examination respectively. Clinical examination and ETDRS fundus photographs showed statistically significant substantial agreement in detecting DR severity (p<0,001). Clinical examination and ETDRS Field 2 fundus photograph showed statistically significant moderate agreement in detecting DR severity (p<0,001). Clinical examination and OCT findings also showed statistically significant substantial agreement in detecting DME (p<0,001). ETDRS fundus photographs and OCT findings showed statistically significant moderate agreement in detecting DME (p<0,001). Conclusion: In evaluation of DR severity; ETDRS fundus photography and clinical examination findings showed important agreement, whilst ETDRS Field 2 and clinical examination showing moderate agreement. Our clinical examination findings are effective in evaluation of DME presence.