RT Journal Article
SR Electronic
T1 Evaluation of diabetic retinopathy severity on ultrawide field colour images compared with ultrawide fluorescein angiograms
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP bjo-2022-322163
DO 10.1136/bjo-2022-322163
A1 Mohamed Ashraf
A1 Omar AbdelAl
A1 Siamak Shokrollahi
A1 Cloyd M Pitoc
A1 Lloyd Paul Aiello
A1 Paolo S Silva
YR 2023
UL http://bjo.bmj.com/content/early/2023/01/19/bjo-2022-322163.abstract
AB 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 are available on reasonable request.