The recent coronavirus disease 2019 (COVID-19) pandemic has forced the medical community to revise and reorganize the methods of clinical evaluation, particularly in ophthalmology: despite being the current gold standard for the examination of retinal periphery, indirect ophthalmoscopy, as well as central fundus biomicroscopy for macular disorders, require a close contact with the patient and need adequate time of evaluation 1, 2, 3. Although the clinician should be aware of the possibility that a minority of the most peripheral lesions may be not entirely visualized, it might be considered a first line diagnostic modality, in the context of a full ophthalmological examination. UWF fundus imaging might be an alternative to ophthalmoscopy, since it allows to accurately classify major retinal diseases, widening the range of disorders possibly diagnosed with teleophthalmology. The inter-grader agreement for images classification was perfect (kappa = 0.998, 95% Confidence Interval (95%CI) = 0.997–0.999), as the two methods concordance for retinal diseases diagnosis (kappa = 0.997, 95%CI = 0.996–0.999) without statistically significant difference. Each eye was classified by a clinical grader and two image graders in the following groups: normal retina, diabetic retinopathy, vascular abnormalities, macular degenerations and dystrophies, retinal and choroidal tumors, peripheral degenerative lesions and retinal detachment and myopic alterations. Each patient underwent indirect ophthalmoscopic evaluation, with scleral depression and/or fundus biomicroscopy, when clinically indicated, and mydriatic UWF fundus imaging by means of CLARUS 500™ fundus camera. Patients examined for presumed major retinal disorders were consecutively enrolled. To analyze the performance of ultra-wide-field (UWF) fundus photography compared with ophthalmoscopy in identifying and classifying retinal diseases.
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