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Shlomit F. Sandler, Steven D. Schwartz, Umar Mian, Irena Tsui; Prospective Study Comparing Ultra-wide-field versus Conventional Imaging for the Detection and Management of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3297.
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To compare clinical exam, conventional color fundus photos (CCFP), ultra-wide-field color fundus photos (UWFCFP), conventional fluorescein angiography (CFA), and ultra-wide-field fluorescein angiography (UWFFA) in the imaging, detection and management of diabetic retinopathy (DR).
Patients with DR detected on clinical exam at the Montefiore Medical Center in the Bronx, NY were prospectively enrolled. All patients underwent dilated fundus exam (DFE) by a vitreoretinal specialist, as well as conventional and ultra-wide-field color fundus photos and fluorescein angiography by both CFA (Topcon, Paramus, NJ) and UWFFA (Optos, Marlborough, MA) on different days but within the same week. All images were reviewed in a masked fashion by a vitreoretinal specialist who graded the severity of retinopathy using the International Classification of DR.
Twenty-nine (29) eyes of 15 diabetic patients were included. One thousand fifteen (1015) images were obtained and reviewed. Significantly fewer color fundus photos were obtained using the ultra-wide-field technology (mean: UWFCFP 2.14 vs. CCFP 8.41, p<0.0001), however there was no significant difference between the number of images obtained during FA between the two devices (mean: UWFFA 11.52 vs. CFA 12.93, p=0.11). There was limited agreement in DR staging across all 5 diagnostic modalities (Table). Ultra-wide-field color fundus photographs detected no retinopathy in 17.2% of patients, thus underestimating the severity of DR compared to clinical exam and other imaging modalities. DME was noted more frequently by CFA (75.9%) or UWFFA (69.0%) than CCFP (20.7%), UWFCFP (24.1%) or clinical exam (10.3%). Peripheral vascular leakage was significantly more visible on UWFFA than CFA (8 vs.1 eye).
This is the first study directly comparing UWFFA and CFA performed on the same eyes within the same week. Information available from ultra-wide-field imaging and conventional imaging had different advantages and disadvantages. Therefore, physicians should choose which modality to use based on patient pathology.
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