Detection of Drusen and Early Signs of Age-related Maculopathy Using a Nonmydriatic Camera and a Standard Fundus Camera

Purpose: The study was designed to compare the severity of age-related maculopathy as graded from photographs taken using three different techniques. Methods: Two methods of nonstereoscopic 45° retinal photography of the macula (through a nonpharmacologically dilated pupil and through a pharmacologically dilated pupil) were compared with results from standard 30° stereoscopic photographs in 112 subjects. Corresponding photographic fields were graded by a masked grader for the presence of any drusen, soft drusen, retinal pigment epithelial degeneration, increased retinal pigmentation, and early and late age-related maculopathy. Results: Exact agreement between gradings of the 45° photographs taken through nonpharmacologically dilated pupils and 30° photographs taken through dilated pupils was 75% for any drusen, 72% for soft drusen, 72% for retinal pigment epithelial degeneration, 74% for increased retinal pigment, 85% for pure geographic atrophy, and 89% for exudative macular degeneration. The kappa scores varied from 0.33 for geographic atrophy to 0.60 for exudative macular degeneration. Slightly higher rates of agreement between gradings were found after dilation. Conclusion: These data suggest that 45° nonstereoscopic fundus photographs, when graded according to a standard classification scheme, should be considered for detection of age-related maculopathy in situations where the pupils cannot be pharmacologically dilated and retinal specialists are not available to examine the fundus.