June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Comparison of Diabetic Retinopathy Severity Identified on Ultrawide Field Retinal Images and Ultrawide Field Fluorescein Angiograms
Author Affiliations & Notes
  • Joanne Tayapad Rocha
    Ophthalmology, The Medical City, Pasig City, Philippines
  • April N. Bustamante
    Ophthalmology, The Medical City, Pasig City, Philippines
  • Milagros H. Arroyo
    Ophthalmology, The Medical City, Pasig City, Philippines
    American Eye Center, Makati, Philippines
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Joanne Rocha, None; April Bustamante, None; Milagros Arroyo, Allergan (C), Bayer (C), Novartis (C); Jennifer Sun, None; Lloyd Aiello, Optos (R), Optos (F); Paolo Silva, Optos (F)
  • Footnotes
    Support  Massachusetts Lions’ Eye Research Fund, Balik-Scientist Program of the Depatment of Science and Technology, Republic of the Philippines
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 64. doi:
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    • Get Citation

      Joanne Tayapad Rocha, April N. Bustamante, Milagros H. Arroyo, Jennifer K Sun, Lloyd P Aiello, Paolo Sandico Silva; Comparison of Diabetic Retinopathy Severity Identified on Ultrawide Field Retinal Images and Ultrawide Field Fluorescein Angiograms. Invest. Ophthalmol. Vis. Sci. 2017;58(8):64.

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

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Abstract

Purpose : To compare diabetic retinopathy (DR) severity identified on ultrawide field (UWF) retinal images with UWF fluorescein angiography (UWF-FA).

Methods : Mydriatic phase-plate adjusted UWF 200o retinal imaging and UWF-FA were performed in 100 consecutive eyes with no evidence of panretinal laser or nonDR retinal vascular disease. Stereographically projected images were evaluated at a centralized reading center. Specific diabetic lesions and clinical DR severity were graded. Presence of retinal nonperfusion (NP) in each retinal field was determined. A retina specialist experienced in grading UWF-FA (PSS) performed side-by-side comparison adjudication of DR severity discrepancies. Simple (K) and weighted (linear scale, KW) kappa statistics assessed agreement.

Results : Distribution of DR severity using UWF images vs UWF-FA: no DR, 28% vs 3%; mild nonproliferative DR (NPDR), 18% vs 32%; moderate NPDR, 27% vs 18%; severe NPDR, 13% vs 29%; proliferative DR (PDR), 11% vs 15%; and high-risk PDR, 3% vs 3%. Agreement between UWF and UWF-FA for DR severity was K=0.3496 and Kw=0.6568. DR severity between UWF and UWF-FA images was within 1-step in 94% of eyes and exact in 46%. There was exact agreement in all eyes with PDR (N=14) on UWF images. No eye was graded more severe on UWF images than on UWF-FA. UWF-FA identified more severe DR in 54% of all eyes and in 89.3%, 44.5%, 70.4%, and 15.4% of eyes with no, mild, moderate and severe NPDR. Predominantly peripheral lesions (PPL) on UWF images were more common with increasing DR severity [33%(6) mild NPDR, 41%(11) moderate, 69%(9) severe, 93%(13) PDR; p<0.0001] and were significantly associated with NP on UWF-FA (No PPL 36% vs PPL 84.6%, p<0.0001). NP on UWF-FA images was identified in 12.5% (4) of eyes with mild NPDR, 55% (10) moderate, 79.3% (23) severe and 100% (18) PDR.

Conclusions : Historically, the use of standard ETDRS-FA did not provide substantial clinical benefit in predicating DR progression as compared with ETDRS retinal photography. However, this study demonstrates that in eyes with less severe levels of DR, UWF-FA identifies more severe DR earlier and allows for identification of NP that is not readily evident on UWF color images. If early findings are confirmed, UWF-FA may prove important for early identification of DR and refining the risk of DR progression and visual loss.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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