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Abstract
Purpose To compare Early Treatment Diabetic Retinopathy Study (ETDRS) diabetic retinopathy (DR) severity on ultrawide field (UWF) colour imaging (CI) and UWF fluorescein angiography (FA).
Design Cross-sectional retrospective review.
Subjects Patients with diabetes mellitus and at least mild non-proliferative DR on UWF-CI.
Methods UWF-CI and UWF-FA images acquired within 1 month of each other were evaluated independently using ETDRS DR Severity Scale (DRSS) for colour photography adapted for UWF-CI and UWF-FA. Extent of non-perfusion (NP, mm2) was determined from UWF-FA images.
Main outcome measures Agreement rate between DRSS on UWF-CI and UWF-FA.
Results Images from 218 eyes of 137 patients with diabetes were evaluated. Agreement rate for DRSS between UWF-CI and UWF-FA was moderate to substantial (K=0.46, Kw=0.65). Over-all, DRSS was worse in 73 (33.5%) eyes on UWF-FA and in 16 (7.3%) on UWF-CI. Compared to UWF-CI, UWF-FA identified more severe DRSS in 26.5% (1 step) and 7.34% (≥2 steps) of eyes. DRSS was worse than UWF-FA in 56 (51.4%) in early DR (ETDRS levels 20–47, N=109) and 17 (15.6%) in eyes with severe DR (53 and higher, N=109). In this cohort, the extent of NP significantly increased as eyes approach moderate non-proliferative DR (levels 43–47, p=0.0065).
Conclusion When evaluating UWF-FA images using the ETDRS colour severity scale, DRSS is graded as more severe in a substantial number of eyes than when evaluating UWF-CI. It is uncertain how the DRSS levels using UWF-FA translate to clinical outcomes, but the additional lesions detected might provide added prognostic value. These and other recent data emphasise the need of obtaining outcome data based on UWF-FA and the potential need to develop DRSS specifically tailored for UWF-FA images.
Data availability statement
Data are available on reasonable request.
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Data availability statement
Data are available on reasonable request.
Footnotes
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Contributors MA: draft and critical revision, concept and design, acquisition, analysis. OA: acquisition, critical revision of the manuscript, technical support. SS: acquisition, critical revision of the mauscript, technical support. CMP: acquisition, critical revision of the manuscript, technical support. LPA: obtain funding, administrative, technical and material support, concept and design, critical revision. PSS: administrative, technical and material support, supervision, concept and design, critical revision. MA and PSS are guarantors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MA: none OA: none SS: none CMP: none. LPA: Personal Financial Interest—Kalvista, outside of the submitted work; Consultant—Novo Nordisk, Kalvista, Optos, outside of the submitted work. PSS: Research support—Optomed, Hillrom, Optos, Kubota Vision outside of the submitted work. Personal Fees—Novartis, Roche, Bayer outside of the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.
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