Myopic Retinal Changes Screening: Comparison of Sensitivity and Specificity among 15 Combinations of Ultrawide Field Scanning Laser Ophthalmoscopy Images

Abstract

<b><i>Aim:</i></b> The objective of the study was 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. <b><i>Methods:</i></b> This is a retrospective study of UWF SLO images obtained from myopes and were analyzed by 2 retinal specialists independently. Five 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 1 to 4 fields of the retina were compared to determine the abilities of each combination screens for MRC. <b><i>Results:</i></b> UWF SLO images obtained from 823 myopic patients (1,646 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%). <b><i>Conclusions:</i></b> 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.