Abstract
Purpose:
To investigate the effectiveness of ultra-wide field angiography in evaluating diabetic retinopathy versus traditional 7 field angiography
Methods:
CPT codes were used to generate a report of all Diabetic patients who had received a fluoroscein angiogram with the Optos (Optos plc) ultra-wide field imaging system since January 2014. Images from the Optos image database were then collected and those that were of poor quality were excluded. The remainder of the images were evaluated for single frames that provided the highest diagnostic yield and these single frames were printed on standard photo paper. A stencil cut-out was then made to "crop" the ultra-wide field image and show only the areas that are included in the standard 7 field (ETDRS) collage. A diagnosis was made by a single Vitreoretinal surgeon using this 7 field collage stencil and then again with the stencil removed. Thus 7 field collage was directly compared to ultra-wide imaging for the same fluoroscein angiogram image. Images were then classified into four categories: Level 0 images had no difference in information, diagnosis, or treatment basis between ultra-wide and 7 field. Level 1 images revealed additional information with the ultra-wide image, but no change in diagnosis or treatment. Level 2 images revealed additional information that altered the diagnosis but did not change the treatment plan. Level 3 images revealed information that changed both the diagnosis and the treatment plan.
Results:
This study evaluated 366 photos, 21 (5.7%) level 0, 294 (80.3%) level 1, 36 (9.8%) level 2, and 25 (6.8%) level 3. Thus, there were only 5.7% of the images in which the Optos did not provide any additional information compared to the 7 field collage while 94.3% at least revealed additional information and in some cases even affected the diagnosis and treatment decisions.
Conclusions:
Ultra-wide field angiography has a clear benefit when monitoring diabetic retinopathy and should be the standard of care. Ultra-wide field angiography provides valuable information of the retinal periphery that is not seen in standard 7 field imaging and can change the diagnosis and treatment plans of patients.