scholarly journals Myopic retinal changes screening: comparison of sensitivity and specificity among 15 combinations of ultrawide field scanning laser ophthalmoscopy images

2021 ◽  
Author(s):  
Xuan Deng ◽  
Silvia Tanumiharjo ◽  
Qianyin Chen ◽  
Shengnan Li ◽  
Huimin Lin ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Confidence Interval ◽  
Diagnostic Test ◽  
Scanning Laser ◽  
Test Accuracy ◽  
Scanning Laser Ophthalmoscopy ◽  
Reference Standard ◽  
High Performing ◽  
Primary Screening ◽  
Optimal Evaluation

Aims: To investigate the evaluation indices (diagnostic test accuracy and agreement) of 15 combinations of ultrawide field scanning laser ophthalmoscopy (UWF SLO) images in myopic retinal changes (MRC) screening to determine the combination of imaging that yields the highest evaluation indices in screening MRC. Methods: This is a retrospective study of UWF SLO images obtained from myopes and were analyzed by two retinal specialists independently. 5-field UWF SLO images that included the posterior (B), superior (S), inferior (I), nasal (N) and temporal (T) regions were obtained for analysis and its results used as a reference standard. The evaluation indices of different combinations comprising of one to four fields of the retina were compared to determine the abilities of each combinations screen for MRC. Results: UWF SLO images obtained from 823 myopic patients (1646 eyes) were included for the study. Sensitivities ranged from 50.0% to 98.9% (95% confidence interval (CI), 43.8-99.7%); the combinations of B+S+I (97.3%; 95% CI, 94.4-98.8%), B+T+S+I (98.5%; 95% CI, 95.9-99.5%), and B+S+N+I (98.9%; 95% CI, 96.4-99.7%) ranked highest. Furthermore, the combinations of B+S+I, B+T+S+I and B+S+N+I also revealed the highest accuracy (97.7%; 95% CI, 95.1-100.0%, 98.6%; 95% CI, 96.7-100.0%, 98.8%; 95% CI, 96.9-100.0%) and agreement (Kappa = 0.968, 0.980 and 0.980). For the various combinations, specificities were all higher than 99.5% (95% CI, 99.3-100.0%). Conclusion: In our study, screening combinations of B+S+I, B+T+S+I and B+S+N+I stand out with high-performing optimal evaluation indices. However, when time is limited, B+S+I may be more applicable in primary screening of MRC.

scholarly journals Observed Differences in Diagnostic Test Accuracy between Patient Subgroups: Is It Real or Due to Reference Standard Misclassification?

2007 ◽  
Vol 53 (10) ◽  
pp. 1725-1729 ◽  
Author(s):  
Corné Biesheuvel ◽  
Les Irwig ◽  
Patrick Bossuyt
Keyword(s):  
Clinical Practice ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Reference Standard ◽  
Target Condition ◽  
Test Sensitivity ◽  
The Past ◽  
Patient Subgroups

Abstract Before a new test is introduced in clinical practice, its accuracy should be assessed. In the past decade, researchers have put an increased emphasis on exploring differences in test sensitivity and specificity between patient subgroups. If the reference standard is imperfect and the prevalence of the target condition differs among subgroups, apparent differences in test sensitivity and specificity between subgroups may be caused by reference standard misclassification. We provide guidance on how to determine whether observed differences may be explained by reference standard misclassification. Such misclassification may be ascertained by examining how the apparent sensitivity and specificity change with the prevalence of the target condition in the subgroups.

Tear film evaluation by scanning laser ophthalmoscopy during retinal imaging

2018 ◽  
Vol 28 (6) ◽  
pp. 670-676
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Maria Laura Gomez ◽  
Natalie Afshari ◽  
Dirk-Bartsch Uwe ◽  
Amit Meshi ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dry Eye ◽  
Odds Ratio ◽  
Tear Film ◽  
Scanning Laser ◽  
Scanning Laser Ophthalmoscopy ◽  
Reticular Pattern ◽  
Multicolor Imaging ◽  
Tear Meniscus ◽  
Tear Meniscus Height

Purpose: Herein, we describe a novel finding which appears as a reticular pattern on multicolor confocal scanning laser ophthalmoscopy image during routine imaging of retina and we aim to show whether there is an association between this pattern and dry eye findings. Materials and methods: A total of 162 eyes of 81 patients that were scheduled for a routine retinal imaging by scanning laser ophthalmoscopy at a vitreoretinal practice underwent dry eye evaluation including corneal and conjunctival lissamine green staining, fluorescein staining, tear break-up time, and tear meniscus height measurement before acquiring any images. Then, multicolor images were taken and graded for the severity of reticular pattern. Results: Among 150 eyes of 81 patients with gradable multicolor imaging, 45 eyes (30%) had some reticular pattern on multicolor image. Severity of reticular pattern on multicolor imaging was significantly correlated with total lissamine score (rho = 0.378, p = 0.007) and tear meniscus height (rho = −0.408, p = 0.011). Furthermore, they were found to be the best set of predictors for the severity pattern on multicolor imaging (odds ratio = 1.30, 95% confidence interval = 1.01–1.37, p = 0.027 and odds ratio = 0.25, 95% confidence interval = 0.128–0.342, p < 0.001, respectively). Conclusion: Reticular pattern seen on multicolor image while acquiring retinal images using scanning laser ophthalmoscopy may be related to tear film instability. Further modulations of the scanning laser ophthalmoscopy instrument will likely improve this indicator of dry eye syndrome.

Ultra-wide-field scanning laser ophthalmoscopy and optical coherence tomography in FEVR: findings and its diagnostic ability

2020 ◽  
pp. bjophthalmol-2020-316226
Author(s):  
Ting Zhang ◽  
Zhirong Wang ◽  
Limei Sun ◽  
Songshan Li ◽  
Li Huang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diagnostic Test ◽  
Clinical Significance ◽  
Screening Strategy ◽  
Scanning Laser ◽  
Youden Index ◽  
Wide Field ◽  
Scanning Laser Ophthalmoscopy ◽  
Healthy Controls ◽  
Optical Coherence

Background/Aims To describe some novel vitreoretinal microstructural findings in patients with mild familial exudative vitreoretinopathy (FEVR) on ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and UWF optical coherence tomography (UWF-OCT) and to evaluate their clinical significance.MethodsA total of 32 patients and 32 healthy controls were studied. An additional independent 40 FEVR patients, 44 patients with non-FEVR retinopathies and 40 healthy controls participated in a diagnostic test to validate the abilities of novel findings in FEVR screening.ResultsA novel anatomic change, named Temporal Mid-Peripheral Vitreoretinal Interface Abnormality (TEMPVIA), was found on UWF-SLO in 88.3% of FEVR patients and in none of the healthy controls. The clinical significance of TEMPVIA was further validated by a diagnostic test in new independent cases, with satisfying sensitivity (91.5%) and specificity (98.8%) and Youden Index 0.90. In addition to foveal hypoplasia, some previously unrecognised, novel clinical changes in FEVR, for instance, retinoschisis, focal retinal thickening, sudden thinning of the retina and retinal ridge, were identified using UWF-OCT.ConclusionThe results of this study have led to an update of the clinical spectrum of FEVR and have improved our understanding of its pathogenesis. TEMPVIA is therefore suggested to be a useful biomarker in the screening strategy for mild FEVR.

scholarly journals Use of Smartphones to Detect Diabetic Retinopathy: Scoping Review and Meta-Analysis of Diagnostic Test Accuracy Studies (Preprint)

2019 ◽  
Author(s):  
Choon Han Tan ◽  
Bhone Myint Kyaw ◽  
Helen Smith ◽  
Colin S Tan ◽  
Lorainne Tudor Car
Keyword(s):  
Diabetic Retinopathy ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Fundus Photography ◽  
Diabetic Patients ◽  
Test Accuracy ◽  
Reference Standard

BACKGROUND Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphone ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible, and easier to use than conventional methods. OBJECTIVE This study aimed to determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. METHODS We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients, which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR to an accurate or commonly employed reference standard, such as indirect ophthalmoscopy, slit-lamp biomicroscopy, and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data, and assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies–2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines. RESULTS In all, nine studies involving 1430 participants were included. Most studies were of high quality, except one study with limited applicability because of its reference standard. The pooled sensitivity and specificity for detecting any DR was 87% (95% CI 74%-94%) and 94% (95% CI 81%-98%); mild nonproliferative DR (NPDR) was 39% (95% CI 10%-79%) and 95% (95% CI 91%-98%); moderate NPDR was 71% (95% CI 57%-81%) and 95% (95% CI 88%-98%); severe NPDR was 80% (95% CI 49%-94%) and 97% (95% CI 88%-99%); proliferative DR (PDR) was 92% (95% CI 79%-97%) and 99% (95% CI 96%-99%); diabetic macular edema was 79% (95% CI 63%-89%) and 93% (95% CI 82%-97%); and referral-warranted DR was 91% (95% CI 86%-94%) and 89% (95% CI 56%-98%). The area under SROC curve ranged from 0.879 to 0.979. The diagnostic odds ratio ranged from 11.3 to 1225. CONCLUSIONS We found heterogeneous evidence showing that smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference criteria and classification criteria and evaluate other available forms of smartphone ophthalmoscopy in primary care settings.

scholarly journals Quantifying the Accuracy of a Diagnostic Test or Marker

2012 ◽  
Vol 58 (9) ◽  
pp. 1292-1301 ◽  
Author(s):  
Kristian Linnet ◽  
Patrick M M Bossuyt ◽  
Karel G M Moons ◽  
Johannes B Reitsma
Keyword(s):  
Diagnostic Test ◽  
Prospective Cohort ◽  
Roc Curves ◽  
Test Accuracy ◽  
Index Test ◽  
Reference Standard ◽  
Single Test ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Cohort Design

Abstract BACKGROUND In recent years, increasing focus has been directed to the methodology for evaluating (new) tests or biomarkers. A key step in the evaluation of a diagnostic test is the investigation into its accuracy. CONTENT We reviewed the literature on how to assess the accuracy of diagnostic tests. Accuracy refers to the amount of agreement between the results of the test under evaluation (index test) and the results of a reference standard or test. The generally recommended approach is to use a prospective cohort design in patients who are suspected of having the disease of interest, in which each individual undergoes the index and same reference standard tests. This approach presents several challenges, including the problems that can arise with the verification of the index test results by the preferred reference standard test, the choice of cutoff value in case of a continuous index test result, and the determination of how to translate accuracy results to recommendations for clinical use. This first in a series of 4 reports presents an overview of the designs of single-test accuracy studies and the concepts of specificity, sensitivity, posterior probabilities (i.e., predictive values) for the presence of target disease, ROC curves, and likelihood ratios, all illustrated with empirical data from a study on the diagnosis of suspected deep venous thrombosis. Limitations of the concept of the diagnostic accuracy for a single test are also highlighted. CONCLUSIONS The prospective cohort design in patients suspected of having the disease of interest is the optimal approach to estimate the accuracy of a diagnostic test. However, the accuracy of a diagnostic index test is not constant but varies across different clinical contexts, disease spectrums, and even patient subgroups.

scholarly journals Ultrasonography for the diagnosis of extra-cranial carotid occlusion – diagnostic test accuracy meta-analysis

VASA ◽  
2020 ◽  
Vol 49 (3) ◽  
pp. 195-204
Author(s):  
Djamila M. Rojoa ◽  
Ahmad Q. D. Lodhi ◽  
Nikos Kontopodis ◽  
Christos V. Ioannou ◽  
Nicos Labropoulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Carotid Occlusion ◽  
Test Accuracy ◽  
Free Text ◽  
Correct Identification ◽  
Reference Standard

Summary: Background: The correct diagnosis of internal carotid artery (ICA) occlusion is crucial as it limits unnecessary intervention, whereas correct identification of patients with severe ICA stenosis is paramount in decision making and selecting patients who would benefit from intervention. We aimed to evaluate the accuracy of ultrasonography (US) in the diagnosis of ICA occlusion. Methods: We conducted a systematic review in compliance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) of diagnostic test accuracy studies. We interrogated electronic bibliographic sources using a combination of free text and thesaurus terms to identify studies assessing the diagnostic accuracy of US in ICA occlusion. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity. We developed hierarchical summary receiver operating characteristic (HSROC) curves. Results: We identified 23 studies reporting a total of 5,675 arteries of which 722 were proven to be occluded by the reference standard. The reference standard was digital subtraction or cerebral angiography in all but two studies, which used surgery to ascertain a carotid occlusion. The pooled estimates for sensitivity and specificity were 0.97 (95% confidence interval (CI) 0.94 to 0.99) and 0.99 (95% CI 0.98 to 1.00), respectively. The diagnostic odds ratio was 3,846.15 (95% CI 1,375.74 to 10,752.65). The positive and negative likelihood ratio were 114.71 (95% CI 58.84 to 223.63) and 0.03 (95% CI 0.01 to 0.06), respectively. Conclusions: US is a reliable and accurate method in diagnosing ICA occlusion. US can be used as a screening tool with cross-sectional imaging being reserved for ambiguous cases.

scholarly journals Use of Smartphones to Detect Diabetic Retinopathy: Scoping Review and Meta-Analysis of Diagnostic Test Accuracy Studies

10.2196/16658 ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. e16658
Author(s):  
Choon Han Tan ◽  
Bhone Myint Kyaw ◽  
Helen Smith ◽  
Colin S Tan ◽  
Lorainne Tudor Car
Keyword(s):  
Diabetic Retinopathy ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Fundus Photography ◽  
Diabetic Patients ◽  
Test Accuracy ◽  
Reference Standard

Background Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphone ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible, and easier to use than conventional methods. Objective This study aimed to determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. Methods We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients, which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR to an accurate or commonly employed reference standard, such as indirect ophthalmoscopy, slit-lamp biomicroscopy, and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data, and assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies–2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines. Results In all, nine studies involving 1430 participants were included. Most studies were of high quality, except one study with limited applicability because of its reference standard. The pooled sensitivity and specificity for detecting any DR was 87% (95% CI 74%-94%) and 94% (95% CI 81%-98%); mild nonproliferative DR (NPDR) was 39% (95% CI 10%-79%) and 95% (95% CI 91%-98%); moderate NPDR was 71% (95% CI 57%-81%) and 95% (95% CI 88%-98%); severe NPDR was 80% (95% CI 49%-94%) and 97% (95% CI 88%-99%); proliferative DR (PDR) was 92% (95% CI 79%-97%) and 99% (95% CI 96%-99%); diabetic macular edema was 79% (95% CI 63%-89%) and 93% (95% CI 82%-97%); and referral-warranted DR was 91% (95% CI 86%-94%) and 89% (95% CI 56%-98%). The area under SROC curve ranged from 0.879 to 0.979. The diagnostic odds ratio ranged from 11.3 to 1225. Conclusions We found heterogeneous evidence showing that smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference criteria and classification criteria and evaluate other available forms of smartphone ophthalmoscopy in primary care settings.

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