Detection of age-related macular degeneration using a nonmydriatic digital camera and a standard film fundus camera

Objective: To compare gradings of lesions associated with age-related macular degeneration (AMD) from digital and stereoscopic film images. Design: Instrument validation study. Participants: Sixty-two subjects (124 eyes) with varying degrees of AMD, including no AMD. Methods: images of the optic disc and macula were taken using a 45degrees digital camera (6.3 megapixels) through dark-adapted pupils and pharmacologically dilated pupils. In addition, 30degrees stereoscopic retinal film images were taken through pharmacologically dilated pupils of the same eyes. All images were graded for drusen size, type, and area; pigmentary abnormalities; geographic atrophy; and neovascular lesions using the modified Wisconsin Age-Related Maculopathy Grading System. Exact agreement and unweighted kappa scores were calculated for paired gradings resulting from digital and film images. Main Outcome Measure: Agreement between gradings obtained from stereoscopic slide transparencies and digital nonstereoscopic images. Results: Exact agreement between gradings of digital and stereoscopic film images taken through pharmacologically dilated pupils was 91% (kappa=0.85) for the categories of none, early AMD, and late AMD. Exact agreement for gradings of digital images taken through dark-adapted pupils compared with gradings of film images was 80% (kappa=0.69). Exact agreement for gradings of digital images captured through dark-adapted and pharmacologically dilated pupils was 86% (kappa=0.78). In addition, kappa scores for agreement between different approaches for individual lesions were moderate to almost perfect. Conclusions: Gradings resulting from high-resolution digital images, especially when the pupil is pharmacologically dilated, are comparable with those resulting from film-based images. We conclude that digital imaging of the retina is useful for epidemiological studies of AMD.