Diabetic maculopathy: multicolour and SD-OCT versus fundus p
The English Diabetic Eye Screening (DES) program recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. Researchers compared multicolor versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral-domain optical coherence tomography (SD-OCT) identifying macular thickening.

This cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolor and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolor and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT.

Intergrader agreement on grading maculopathy using fundus photography (Cohen’s =0.91) and multicolor (Cohen’s =0.82) was ‘almost perfect. Agreement between fundus photography and multicolor on grading maculopathy (Cohen’s=0.76) was ‘substantial’. Compared with fundus photography, multicolor had a sensitivity of 87% and specificity of 90% in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular edema requiring urgent intervention were also missed on fundus photography but not on multicolor. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular edema.

Multicolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolor/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.