OBJECTIVE: To determine the sensitivity and specificity of the conventional direct ophthalmoscope and the PanOptic ophthalmoscope in the detection of sight threatening retinopathy, as well as the "Ease of Use" of these equipments.
METHODS: 200 diabetics, newly referred from primary health physicians were examined. Fundus examinations were performed with pupil dilatation in a dark room. The examinations were performed by a single investigator using the PanOptic ophthalmoscope, the conventional direct ophthalmoscope and slit lamp biomicroscopy.
RESULTS: The overall sensitivity in detecting sight threatening retinopathy using the conventional direct ophthalmoscope was 73.2% (95% CI: 57.1-85.8%), specificity 93.7% (95% CI: 88.7-96.9%). For PanOptic ophthalmoscope, the overall sensitivity in detecting sight threatening retinopathy was 58.5% (95% CI: 42.1-73.7%), specificity 93.7% (95% CI: 88.7-96.9%). The conventional direct ophthalmoscope was 1.38 times (95% CI: 1.17-1.61 times) as easy to use compared to the PanOptic ophthalmoscope.
CONCLUSION: The PanOptic ophthalmoscope is not superior to the conventional direct ophthalmoscope for the screening of Sight Threatening Retinopathy.
KEYWORDS: PanOptic ophthalmoscope; conventional direct ophthalmoscope; sight threatening retinopathy
Study site: Ophthalmology clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia
A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.