May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Digital vs. Film Stereo Color Retinal Images for Grading Diabetic Retinopathy Severity
Author Affiliations & Notes
  • H. K. Li
    Ophthalmology & Visual Science, Univ of Texas Medical Branch, Galveston, Texas
    Sch of Health Info Sci, Univ of Texas Health Science Center, Houston, Texas
  • L. D. Hubbard
    Dept of Ophth & Vis Sci, Univ of Wisconsin-Madison, Madison, Wisconsin
  • R. P. Danis
    Dept of Ophth & Vis Sci, Univ of Wisconsin-Madison, Madison, Wisconsin
  • T. Harding
    Dept of Ophth & Vis Sci, Univ of Wisconsin-Madison, Madison, Wisconsin
  • J. F. Florez-Arango
    Sch of Health Info Sci, Univ of Texas Health Science Center, Houston, Texas
    Universidad De Antioquia, Medellin, Colombia
  • E. A. Krupinski
    Dept of Radiology, Univ of Arizona, Tucson, Arizona
  • Footnotes
    Commercial Relationships  H.K. Li, None; L.D. Hubbard, None; R.P. Danis, None; T. Harding, None; J.F. Florez-Arango, None; E.A. Krupinski, None.
  • Footnotes
    Support  Juvenile Diabetes Research Foundation International, New York, NY
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 2748. doi:https://doi.org/
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      H. K. Li, L. D. Hubbard, R. P. Danis, T. Harding, J. F. Florez-Arango, E. A. Krupinski; Digital vs. Film Stereo Color Retinal Images for Grading Diabetic Retinopathy Severity. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2748. doi: https://doi.org/.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose: : To compare diabetic retinopathy (DR) severity levels graded from enhanced stereo color digital retinal images to those graded from slide film photographs.

Methods: : Film (F) and digital (D) color images of 154 eyes of persons with diabetes (pre-selected for full range of DR) were taken with a Topcon 35o camera as 7 stereo fields [7SF] per DRS/ETDRS protocol. Three graders independently determined Early Treatment Diabetic Retinopathy Study(ETDRS) DR level from F (slide transparencies on light boxes with Donaldson viewers) and D (2392 x 2048 pixel, uncompressed images viewed on calibrated 20" LCD monitors with hand-held stereo viewers in Topcon IMAGEnet). Digital images were standardized for brightness, contrast and color balance according to the AREDS2 image model, yielding film-like consistency. In D, the green channel (similar to red-free) was also examined. DR levels were defined by central tendency among graders. Custom software controlled order/timing of grading to minimize bias and recall.

Results: : Graders classified DR from F images as follows: no DR = 26 eyes, non-proliferative DR (NPDR) - 97 eyes (microaneurysms only, mild/moderate/severe = 8/35/25/29), proliferative DR (PDR) = 30 eyes (mild/moderate/severe = 10/10/10), and ungradable DR = 1 eye. Comparison of D vs. F classifications for specific ETDRS level (9-step scale) yielded 66.9% exact agreement and 94.8% +1 step (unweighted Κ = 0.62, SEΚ = 0.04; linear weighted Κ = 0.83, SEΚ = 0.03). For historical comparison, agreement in ETDRS from single replicate gradings of F using the same scale (ETDRS report #12, Ophthalmology 1991) was lower: 53% exact and 88% +1 step (unweighted Κ = 0.42). In our study, variability observed between media was similar to that observed between graders within each medium.

Conclusions: : Comparing D 7SF with F 7SF after standardized enhancement of D, our DR evaluations from D were similar to those from F. Unlike some previous reports using unenhanced digital images which showed lower sensitivity of D for levels defined by subtle abnormalities (microaneurysms, IRMA, new vessels), we found no evidence of systematic disadvantage for D compared to F over a broad range of DR severity.

Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: outcomes/complications • imaging/image analysis: clinical 
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×