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Evaluation of diabetic retinopathy severity on ultrawide field colour images compared with ultrawide fluorescein angiograms
  1. Mohamed Ashraf1,2,3,
  2. Omar AbdelAl1,
  3. Siamak Shokrollahi1,
  4. Cloyd M Pitoc4,
  5. Lloyd Paul Aiello1,2,
  6. Paolo S Silva1,2,4
  1. 1Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
  2. 2Ophthlamology Department, Harvard Medical School, Boston, MA, USA
  3. 3Ophthalmology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
  4. 4University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Paolo S Silva, Joslin Diabetes Center, Boston, MA 02215, USA; paoloantonio.silva{at}joslin.harvard.edu

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.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.