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Comparison of widefield swept-source optical coherence tomography angiography with ultra-widefield colour fundus photography and fluorescein angiography for detection of lesions in diabetic retinopathy
  1. Ying Cui1,2,3,
  2. Ying Zhu1,3,4,
  3. Jay C Wang1,3,
  4. Yifan Lu1,3,
  5. Rebecca Zeng3,5,
  6. Raviv Katz1,3,
  7. Filippos Vingopoulos3,
  8. Rongrong Le3,6,
  9. Inês Laíns1,3,
  10. David M Wu7,
  11. Dean Eliott1,
  12. Demetrios G Vavvas1,
  13. Deeba Husain1,
  14. Joan W Miller1,
  15. Leo A Kim1,
  16. John B Miller1
  1. 1 Retina Service; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
  3. 3 Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
  4. 4 Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
  5. 5 Boston University School of Medicine, Boston University, Boston, Massachusetts, USA
  6. 6 Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
  7. 7 Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr John B Miller, Harvard Medical School, Department of Ophthalmology, Mass. Eye and Ear, Boston, MA 02114, USA; john_miller{at}


Aims To compare widefield swept-source optical coherence tomography angiography (WF SS-OCTA) with ultra-widefield colour fundus photography (UWF CFP) and fluorescein angiography (UWF FA) for detecting diabetic retinopathy (DR) lesions.

Methods This prospective, observational study was conducted at Massachusetts Eye and Ear from December 2018 to October 2019. Proliferative DR, non-proliferative DR and diabetic patients with no DR were included. All patients were imaged with a WF SS-OCTA using a Montage 15×15 mm scan. UWF CFP and UWF FA were taken by a 200°, single capture retinal imaging system. Images were independently evaluated for the presence or absence of DR lesions including microaneurysms (MAs), intraretinal microvascular abnormalities (IRMAs), neovascularisation elsewhere (NVE), neovascularisation of the optic disc (NVD) and non-perfusion areas (NPAs). All statistical analyses were performed using SPSS V.25.0.

Results One hundred and fifty-two eyes of 101 participants were included in the study. When compared with UWF CFP, WF SS-OCTA was found to be superior in detecting IRMAs (p<0.001) and NVE/NVD (p=0.007). The detection rates of MAs, IRMAs, NVE/NVD and NPAs in WF SS-OCTA were comparable with UWF FA images (p>0.05). Furthermore, when we compared WF SS-OCTA plus UWF CFP with UWF FA, the detection rates of MAs, IRMAs, NVE/NVD and NPAs were identical (p>0.005). Agreement (κ=0.916) between OCTA and FA in classifying DR was excellent.

Conclusion WF SS-OCTA is useful for identification of DR lesions. WF SS-OCTA plus UWF CFP may offer a less invasive alternative to FA for DR diagnosis.

  • imaging
  • retina

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  • YC and YZ contributed equally.

  • Contributors YC and YZ: conceptualisation, investigation, formal analysis, writing—original draft. JW: validation, resources, writing—review and editing. YL, RZ and RK: investigation. FV, RL and IL: writing—review and editing. DW, DE, DV, DH, JWM, LK: resources, writing—review and editing. JBM: project administration, supervision, resources, writing—review and editing.

  • Funding This work was supported by Lions Clubs International Foundation Grant 530 125.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board of Massachusetts Eye and Ear (MEE) (reference number 18–125 hour).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified participant data that underline the results reported in this article (text, tables and figures) could be shared upon reasonable request sent to the corresponding author.

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