September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Correlation of Hemorrhages and/or Microaneurysms (H/Ma) Severity and Counts Between Ultrawide Field (UWF) Retinal Imaging and Standard ETDRS Color Stereoscopic Retinal Photography (ETDRS Photos)
Author Affiliations & Notes
  • Hala El Rami
    Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Rasha Barham
    Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Aditi Gupta
    Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Alan Fleming
    Optos plc, Dunfermline Scotland, United Kingdom
  • Jano Van Hemert
    Optos plc, Dunfermline Scotland, United Kingdom
  • Jennifer K Sun
    Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo Sandico Silva
    Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd Paul Aiello
    Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Hala El Rami, None; Rasha Barham, None; Aditi Gupta, None; Alan Fleming, Optos plc (E); Jano Van Hemert, Optos, plc (E); Jennifer Sun, None; Paolo Silva, None; Lloyd Paul Aiello, Optos, plc (R), Optos, plc (F)
  • Footnotes
    Support  Optos plc, Massachusetts Lions Eye Research Fund
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1660. doi:
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    • Get Citation

      Hala El Rami, Rasha Barham, Aditi Gupta, Alan Fleming, Jano Van Hemert, Jennifer K Sun, Paolo Sandico Silva, Lloyd Paul Aiello; Correlation of Hemorrhages and/or Microaneurysms (H/Ma) Severity and Counts Between Ultrawide Field (UWF) Retinal Imaging and Standard ETDRS Color Stereoscopic Retinal Photography (ETDRS Photos). Invest. Ophthalmol. Vis. Sci. 2016;57(12):1660.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the agreement in H/Ma identification and severity between UWF images and ETDRS photos.

Methods : Eyes with no to moderate nonproliferative diabetic retinopathy (NPDR) by ETDRS photos were identified. UWF imaging (stereoscopic 200° pairs of each eye, Optos P200Tx) and ETDRS photos (stereoscopic 35 mm color 7-field 30° photography, Zeiss FF4) were both acquired by standardized protocol at the same visit. H/MA severity was evaluated according to the ETDRS detailed grading scale. H/Ma were counted in ETDRS fields 1-7 and in the UWF areas not covered by ETDRS photos. For localization, UWF images used standardized digitally defined ETDRS photo fields. All images were evaluated at a centralized reading center.

Results : A total of 133 eyes [25 (18.8%) no DR, 47 (35.3%) mild NPDR and 61 (45.9%) moderate] were evaluated and 727/798 (91.1%) fields were gradable for H/Ma in both UWF and ETDRS photos. Simple/weighted kappa agreement for H/MA severity overall and for fields 2-7 were: All=0.61/0.69, F2=0.70/0.77, F3=0.62/0.73, F4=0.50/0.62, F5=0.54/0.65, F6=0.64/0.70, and F7=0.58/0.63. Overall, exact severity agreement was 74.6% and within 1-step in 99.2%. ETDRS photos identified more severe H/Ma in 12% and UWF images in 13%. A mean of 43.4 H/Ma were identified in the ETDRS photo field area compared to 47.8 identified within the same ETDRS area using UWF images (p<0.0001). A total of 15.5 additional H/Ma (35.7% increase) were identified in the peripheral UWF fields. Peripheral H/Ma were identified in 4 (16%) eyes with no DR observed on ETDRS photos.

Conclusions : There is good to excellent agreement between UWF images and ETDRS photos in determining H/Ma severity. There is excellent correlation in identifying H/Ma within ETDRS photo fields, similar to historical ETDRS H/Ma agreement rates. UWF peripheral fields identified 36% more H/Ma, suggesting a more severe H/Ma severity in 13%. Given the UWF:ETDRS H/Ma correlation, additional lesions detected in peripheral fields and known risks associated with peripheral H/Mas, future detailed evaluation of H/Ma counts using UWF images may provide a useful tool for evaluation of disease activity and progression.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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