Nonmydriatic Ultra-Widefield Fundus Photography in a Hematology Clinic Shows Utility for Screening of Sickle Cell Retinopathy

To determine the feasibility and accuracy of nonmydriatic ultra-widefield (UWF) fundus photographs taken in a hematology clinic setting for screening of sickle cell retinopathy (SCR) Prospective cohort study. This single-site study took place at the Johns Hopkins Sickle Cell Center for Adults and th...

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Bibliographic Details
Published in:American journal of ophthalmology 2022-04, Vol.236, p.241-248
Main Authors: Ahmed, Ishrat, Pradeep, Tejus, Goldberg, Morton F., Liu, T.Y. Alvin, Aradhya, Ahimsa, Montana, Manuela P., Photiadis, Natalie, Williams, Elizabeth, Smith, Brantley, Tian, Jing, Lanzkron, Sophie M., Scott, Adrienne W.
Format: Article
Language:English
Subjects:
Adult
Agreements
Anemia, Sickle Cell - complications
Anemia, Sickle Cell - diagnosis
Blood diseases
Caregivers
COVID-19
Diabetes
Diabetic retinopathy
Diabetic Retinopathy - diagnosis
Fundus Oculi
Hematology
Hemoglobin
Hemorrhage
Humans
Lasers
Ophthalmology
Patients
Photography - methods
Prospective Studies
Retina
Retinal detachment
Retinal Diseases - diagnosis
Retinal Diseases - etiology
Stroke
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Summary:To determine the feasibility and accuracy of nonmydriatic ultra-widefield (UWF) fundus photographs taken in a hematology clinic setting for screening of sickle cell retinopathy (SCR) Prospective cohort study. This single-site study took place at the Johns Hopkins Sickle Cell Center for Adults and the Wilmer Eye Institute. The study population was 90 eyes of 46 consecutive adults with sickle cell disease (SCD). Bilateral nonmydriatic fundus photos taken by clinic personnel during the participants’ routine hematology appointment were graded by 2 masked retina specialists at the Wilmer Eye Institute for the presence of nonproliferative SCR (NPSR) and proliferative sickle retinopathy (PSR). A third retina specialist adjudicated in cases of grader disagreement. All participants underwent the standard dilated fundus examination (DFE) within 2 years of acquisition of UWF photographs. The main outcome measure was the sensitivity and specificity of nonmydriatic UWF images for the detection of NPSR and PSR PSR was noted in 19 of 90 eyes that underwent DFE and in 9 of 67 gradable UWF images. Interrater agreement between the 2 graders was moderate, with κ = 0.65 (range 0.43-0.87) for PSR. For gradable UWF photos, the sensitivity and specificity of detecting SCR using the nonmydriatic photos compared with the DFE were 85.2% and 62.5% for NPSR, respectively, and 69.2% and 100% for detection of PSR, respectively. One participant required ophthalmic therapy in both eyes for active sea-fan neovascularization. UWF imaging shows utility in screening for SCR and may help identify patients with PSR who require a DFE and who may benefit from treatment.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2021.10.030