Original articleHemorrhage and/or Microaneurysm Severity and Count in Ultrawide Field Images and Early Treatment Diabetic Retinopathy Study Photography
Section snippets
Methods
Retinal images were reviewed from a previously completed single-site, prospective, clinic-based, comparative-instrument validation study7, 14 that was specifically conducted to evaluate the agreement in assessing severity of DR at the retinal lesion level between stereoscopic mydriatic 200° UWF images and mydriatic ETDRS 7-field 35mm slide film photography (ETDRS photos). Both UWF imaging (stereoscopic 200° pairs of each eye, acquired using an Optos P200Tx, Optos plc, Dunfermline, Scotland, UK)
Results
Retinal images from 126 eyes of 69 patients were evaluated. Based on ETDRS photos, the distribution of DR severity of the eyes was as follows: no DR = 24 (19.0%), mild NPDR = 48 (38.1%), and moderate NPDR = 54 (42.9%). Both UWF and ETDRS photos were gradable for H/Ma severity in 748 of 756 (98.9%) fields. Only 4 (0.5%) and 5 (0.7%) fields were ungradable for H/Ma severity based on ETDRS photos and UWF images, respectively.
Discussion
This study utilizes standardized methods for measuring H/Ma counts that are essential to provide the foundation and rationale for future studies evaluating potentially important parameters that include MA distribution, ratio, and other yet-to-be-determined endpoints. These data demonstrate 2 key aspects of H/Ma identification in UWF images. First, when evaluating similar retinal fields both ETDRS photos and UWF images identify similar numbers of H/Mas. Second, there are up to 50% more H/Mas
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Financial Disclosure(s):
Supported in part by grant funding from the Massachusetts Lions Eye Research Fund to the Joslin Diabetes Center.
P.S.S.: Grant funding – Balik Scientist Program, Department of Science and Technology, Republic of the Philippines.
P.S.S. and L.P.A.: Supported by the Massachusetts Lions Eye Research Fund
A.F. and J.v.H.: Employees of Optos, plc.
L.P.A.: Travel funding only – Optos.
Conflict of Interest Disclosures: Temporary loan of 2 ultrawide field imaging devices was provided to the Joslin Diabetes Center (Optos plc, Dunfermline, Scotland).
Dr Silva had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
None of the sources of funding support had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Author Contributions:
Conception and design: Silva, El-Rami, Barham, Gupta, Fleming, van Hemert, Cavallerano, Sun, Aiello
Analysis and interpretation: Silva, El-Rami, Barham, Gupta, Fleming, van Hemert, Cavallerano, Sun, Aiello
Data collection: Silva, El-Rami, Barham, Gupta, Fleming, van Hemert, Cavallerano, Sun, Aiello
Obtained funding: Silva, Fleming, van Hemert, Aiello
Overall responsibility: Silva, Aiello