Study of Diagnostic Accuracy: Fundus Photography vs. Optical Coherence Tomography

Featured Application This study assesses the diagnostic accuracy of non-mydriatic FP vs. OCT in posterior pole screenings; it determines the level of agreement between optometrist and ophthalmologist in the assessment of retinal abnormalities. It aims to prevent avoidable cases of blindness or low vision in the relevant population by achieving the better and wider detection of pathologies of the posterior pole.Abstract (1) Background: This study aimed to determine the diagnostic accuracy that optical coherence tomography (OCT) can add to fundus photography (FP) in assessing the condition of the retinal posterior pole. (2) Methods: We conducted two blocks of analysis: First, the posterior pole of each eye was examined using an FP non-mydriatic imaging device. Second, OCT was used in addition to FP. After consolidating the specific diagnostic criteria, the assessments were evaluated using two blinded independent investigation groups (by optometrists, and by ophthalmologists who were considered the gold standard). (3) Results: We calculated the diagnostic accuracy of FP compared to OCT and found that they had similar sensitivity. FP had a slightly higher specificity (p-value: 0.01), and OCT had a higher kappa coefficient with 0.50 (95% CI: 0.46-0.55) vs. 0.39 (95% CI: 0.34-0.45) for FP. (4) Conclusions: On the basis that the role of the optometrist in Spain is not to diagnose but to detect lesions and refer patients to an ophthalmologist, the results of this study support the use of OCT, which provided gradable images in almost all examined eyes (97.5%), compared to FP (73.5%). However, optometrists need a detailed and standardized guide in order to conduct evaluations according to the ophthalmologist's criteria.