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Daniel Rock, Lydia Marahrens, Tjalf Ziemssen, Martin Leitritz, Clin Lucien, Focke Ziemssen; Challenges in Grading of Diabetic Retinopathy using Non-mydriatic Wide-field Imaging. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1880.
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© ARVO (1962-2015); The Authors (2016-present)
Large-scale epidemiologic studies described a considerable frequency of retinal microvascular abnormalities, even in the absence of diabetes or hypertension.1 Therefore, we wanted to analyze potential influence factors on grading diabetic retinopathy severity, when analyzing wide-field imaging data of a cross-sectional cohort.
The recruitment of the DiabCheckOCTplus® took place in in 3 secondary diabetes care centers during a period of 4 month. The inclusion criterion was a proven diagnosis of diabetes. The medical history was assessed for all participants. The wide-field photograph was taken using the non-mydriatic OPTOS P200 imaging device (Optos GmbH, Düsseldorf). The patients underwent also spectral-domain optical coherence tomography (OCT, Heidelberg Spectralis).All images were graded using a reading center platform and the ETDRS standard photographs in order to derive the ETDRS severity scale.2,3 The images were analyzed for possible interaction by potential ocular comorbidities. The statistical analyses were performed with SPSS 22 (IBM) (NCT02311504).
1622 images were analyzed for 820 patients with diabetes. Following ocular comorbidities were detected: 12 eyes showed marked vitreous opacity due to asteroid hyalosis or vitreous hemorrhage. 3 eyes had branch vein occlusions, 3 eyes central arterial occlusion, 9 eyes arterial branch occlusion. Scars due to age-related macular degeneration were seen in 37 eyes, chorioretinal scars outside of the macular region in 25 eyes and naevi in 28 eyes. Subretinal fibrosis (3 eyes) or staphyloma (3 eyes). Information of additional OCT and infrared images were used to clarify the concomitant disease.Peripheral lesions, outside of the standard ETDRS fields were seen only in a small fraction of images (1.5%).4 Most changes were bleedings, pigmentary changes or potential vascular variations.
In a typical cohort of patients attending a secondary diabetes centers in Germany, ocular comorbidities – independent of diabetic retinopathy – are not so rare and complicate the clinical grading. Potentially wrong assignments were more frequently seen in the range of 10 to 35 of the EDTRS severity score. While considering more than one imaging modalities might increase the specificity, coexisting ocular and general diseases still cause a frequent need of additional examinations after an image-based screening.
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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