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Purpose: To compare the effectiveness of one- and two-field 45 degrees and 60 degrees fundus photography for detection of retinal neovascularizations (NVEs); to compare the detection of NVEs in macular 45 degrees fields centred on the fovea, between the fovea and the disc and with the nasal border along the nasal disc margin with that in standard 60 degrees one- and two-fields., Methods: Two ophthalmologists assessed red-free, black and white screening and follow-up photographs of 58 out of a total 72 patients referred for treatment for NVEs over the 3 year period 1997-99. The assessment included analysis of the numbers, sizes and locations of NVEs identified in different photographic fields defined by a transparent grid placed over two standard 60 degrees fields., Results: Testing of 45 degrees macular fields disclosed 59/81 (73%), 50/81 (62%) and 64/81 (79%), respectively, of NVEs detected in a 60 degrees fovea-centred photograph. Kappa values for detecting at least one NVE, when present, were 0.62 (95% CI 0.40-0.83), 0.38 (95% CI 0.19-0.57) and 0.83 (95% CI 0.62-0.99). The corresponding figures when compared with two-field 60 degrees photography were 59/111 (53%), 50/111 (45%) and 64/111 (58%), respectively. One macula-centred 60 degrees field disclosed 81/111 (73%) of NVEs detected by 60 degrees two-field photography with an additional optic disc-centred field. Two-field 45 degrees photography disclosed 86/111 (77%) of NVEs detected by two-field 60 degrees photography. A total of 90% of NVEs detected in the optic disc-centred 60 degrees field only were also detected in the corresponding 45 degrees field., Conclusion: One-field 45 degrees photography cannot be recommended as a screening method for diabetic retinopathy. Two-field 45 degrees photography (macula-centred and disc-centred fields) disclosed 77% of NVEs detected by the corresponding two-field 60 degrees photography.

Purpose: To compare the severity level of diabetic retinopathy obtained when assessed from two versus only one 60 degrees photographic field using colour transparencies and red-free, black-and-white photographs. To compare the areal coverage of these two photographic strategies to that of seven-field 30 degrees photography., Methods: Two ophthalmologists graded photographs of 74 eyes of 74 type I and II diabetes patients. Inter-method agreement was expressed in percentages and using kappa statistics and scatter-diagrams. The comparison of the approximate photographic areal coverage was done from diagrams using planimetry., Results: The severity level of retinopathy when judged from two photographic fields was more severe in 13.5% (Grader 1) and in 16.2% (Grader 2) from colour transparencies and in 13.5% (Grader 1) and in 14.9% (Grader 2) from red-free black-and-white prints, as compared to assessments from only one field. Kappa values (0.84-0.86) for inter-method agreement for five pooled retinopathy levels revealed good agreement. Neither grader missed retinopathy requiring clinical assessment or treatment (levels > or = 47) when minimal retinopathy (levels 14-20) was detected using only one 60 degrees colour slide or red-free photograph. A second optic disc-centred field provided valuable additional information when more severe retinopathy lesions (levels > or = 30) were detected in the macula-centred field. One macula-centred 60 degrees photograph covered 60% and two 60 degrees photographs 80% of the area covered by seven-field 30 degrees photography. Two-field 60 degrees photography covers areas left outside seven-field 30 degrees photography., Conclusion: We propose the use of one macula-centred 60 degrees photograph when screening for the first lesions of diabetic retinopathy. After they have been found two-field 60 degrees photography is recommended.

Purpose: To assess the severity of diabetic retinopathy and maculopathy by comparing two different photographic methods; two-field 60 degrees photography using red-free, black-and-white prints and colour transparencies., Methods: Two ophthalmologists independently graded the photographs of 74 patients using grading scales for retinopathy and maculopathy designed for 60 degrees photography. A set of nine 60 degrees red-free, black-and-white standard photographs were chosen to represent the severity of principal diabetic retinopathy and maculopathy abnormalities., Results: The inter-observer agreement for five pooled retinopathy severity levels was 88% (kappa 0.83, weighted kappa 0.96) and 81% (kappa 0.73, weighted kappa 0.89) using red-free, black-and-white prints and colour transparencies respectively. The corresponding figures for six pooled maculopathy levels were 96% (kappa 0.84, weighted kappa 0.97) and 93% (kappa 0.67, weighted kappa 0.86). The analyses revealed that red-free, black-and-white prints disclosed a higher severity level of retinopathy in 83% (Grader 1) and 76% (Grader 2) in those eyes for which the grading was discordant., Conclusion: High-quality monochrome, red-free, wide-angle fundus photographs may be useful for the detection of early and advanced diabetic retinopathy.