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The importance of fluorescein angiography in planning laser treatment of diabetic macular edema.

Publication ,  Journal Article
Kylstra, JA; Brown, JC; Jaffe, GJ; Cox, TA; Gallemore, R; Greven, CM; Hall, JG; Eifrig, DE
Published in: Ophthalmology
November 1999

OBJECTIVE: To test the hypothesis that pretreatment fluorescein angiography (FA) is not necessary for effective laser treatment of patients with clinically significant diabetic macular edema (CSME). DESIGN: Prospective, randomized, controlled treatment simulation. PARTICIPANTS: Six fellowship trained retina specialists. INTERVENTION: The authors compared the ability of four retina specialists (observers) to plan laser treatment with and without the use of FA. One hundred consecutive cases of CSME were selected, each case consisting of a stereo pair of color photographs and a corresponding fluorescein angiogram. These cases were first read by two retina specialists who reached consensus on a treatment plan for each case (standard map). Each of the 4 observers reviewed 50 of these cases on 2 occasions and plotted 2 sets of treatment maps, 1 set created with and 1 without the aid of FA. Each observer's 100 treatment maps were graded for accuracy by comparing them to the corresponding standard maps. The role of FA in improving the accuracy of treatment maps was evaluated using logistic regression analysis to control for different observers, different cases, and different posterior pole characteristics. MAIN OUTCOME MEASURES: Accuracy was defined as the proportion of standard treatment correctly treated by the observer. RESULTS: For the observers as a group, the use of FA improved treatment planning accuracy from 49% to 54.5% (P = 0.02); however, there was significant interobserver variation in performance (P < 0.001). Treatment planning accuracy without and with FA was as follows: observer 1, 40.8% and 40.2%; observer 2, 49.8% and 72%; observer 3, 56.1% and 59.5%; and observer 4, 49.2% and 46.4%. CONCLUSION: The use of FA improves the accuracy of treatment planning for CSME. The authors' study supports the use of FA in laser treatment of patients with CSME.

Duke Scholars

Published In

Ophthalmology

DOI

ISSN

0161-6420

Publication Date

November 1999

Volume

106

Issue

11

Start / End Page

2068 / 2073

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Prospective Studies
  • Photography
  • Patient Care Planning
  • Ophthalmology & Optometry
  • Observer Variation
  • Macular Edema
  • Laser Therapy
  • Humans
  • Fundus Oculi
 

Citation

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Kylstra, J. A., Brown, J. C., Jaffe, G. J., Cox, T. A., Gallemore, R., Greven, C. M., … Eifrig, D. E. (1999). The importance of fluorescein angiography in planning laser treatment of diabetic macular edema. Ophthalmology, 106(11), 2068–2073. https://doi.org/10.1016/S0161-6420(99)90485-2
Kylstra, J. A., J. C. Brown, G. J. Jaffe, T. A. Cox, R. Gallemore, C. M. Greven, J. G. Hall, and D. E. Eifrig. “The importance of fluorescein angiography in planning laser treatment of diabetic macular edema.Ophthalmology 106, no. 11 (November 1999): 2068–73. https://doi.org/10.1016/S0161-6420(99)90485-2.
Kylstra JA, Brown JC, Jaffe GJ, Cox TA, Gallemore R, Greven CM, et al. The importance of fluorescein angiography in planning laser treatment of diabetic macular edema. Ophthalmology. 1999 Nov;106(11):2068–73.
Kylstra, J. A., et al. “The importance of fluorescein angiography in planning laser treatment of diabetic macular edema.Ophthalmology, vol. 106, no. 11, Nov. 1999, pp. 2068–73. Pubmed, doi:10.1016/S0161-6420(99)90485-2.
Kylstra JA, Brown JC, Jaffe GJ, Cox TA, Gallemore R, Greven CM, Hall JG, Eifrig DE. The importance of fluorescein angiography in planning laser treatment of diabetic macular edema. Ophthalmology. 1999 Nov;106(11):2068–2073.
Journal cover image

Published In

Ophthalmology

DOI

ISSN

0161-6420

Publication Date

November 1999

Volume

106

Issue

11

Start / End Page

2068 / 2073

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Prospective Studies
  • Photography
  • Patient Care Planning
  • Ophthalmology & Optometry
  • Observer Variation
  • Macular Edema
  • Laser Therapy
  • Humans
  • Fundus Oculi