July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Automated Hemorrhage and Microaneurysm Counts on Ultrawide Field Images Predict Increased Risk of Diabetic Retinopathy Progression Over 4 Years
Author Affiliations & Notes
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Mohamed Elmasry
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Alex Pisig
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Yousef Aldairy
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • jano van hemert
    Optos plc, Dunfermline, United Kingdom
  • Alan Fleming
    Optos plc, Dunfermline, United Kingdom
  • 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
  • Footnotes
    Commercial Relationships   Paolo Silva, None; Mohamed Elmasry, None; Alex Pisig, None; Yousef Aldairy, None; jano van hemert, Optos plc (E); Alan Fleming, None; Jennifer Sun, None; Lloyd Aiello, None
  • Footnotes
    Support  Massachusetts Lions Eye Research Fund; Balik Scientist Program, Department of Science and Technology, Republic of the Philippines
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 737. doi:
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    • Get Citation

      Paolo Sandico Silva, Mohamed Elmasry, Alex Pisig, Yousef Aldairy, jano van hemert, Alan Fleming, Jennifer K Sun, Lloyd P Aiello; Automated Hemorrhage and Microaneurysm Counts on Ultrawide Field Images Predict Increased Risk of Diabetic Retinopathy Progression Over 4 Years. Invest. Ophthalmol. Vis. Sci. 2018;59(9):737.

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

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Abstract

Purpose : To determine if fully automated computerized detection algorithms applied to ultrawide field (UWF) images can identify the risk of diabetic retinopathy (DR) progression associated with predominantly peripheral hemorrhages and microaneurysms (PPL-HMA).

Methods : Patients with UWF images and 4-year follow-up imaging were identified by electronic medical record review. All baseline UWF images were evaluated using a fully automated HMA detection algorithm to determine HMA count and location within, and peripheral to, the ETDRS 7-standard fields. Algorithm performance AUC was 0.902- 0.948 for mild and moderate nonproliferative DR (NPDR). PPL-HMA were defined as present when at least 1 field had a number of HMAs that were greater in the peripheral retina than within the ETDRS fields. 4-year individual and composite outcomes for DR progression were evaluated [≥2-step progression, development of proliferative diabetic retinopathy (PDR), intravitreal injections (IVT)].

Results : Images from 1,712 eyes with baseline and 4-year follow-up UWF images were reviewed. Mean age was 52.6±16.6 years, diabetes duration 14.0±10.6 years, hemoglobin A1c 8.2%±1.8, 54.4% male, and 87.2% white. Baseline DR severity was: no DR 61.1%(1021), mild 22.4%(375), moderate 8.8%(147), severe 1.9%(32), PDR 4.5%(75), high-risk PDR 1.3%(21). PPL-HMA were present in 16.7%(279) of eyes with increasing frequency in more severe DR (No DR-9.1%, Mild-22.4%, Moderate-29.9%, Severe-46.9%, PDR-40.0%, High-risk-62.0%, trend p<0.0001). Progression rates for PPL-HMA (N=236) versus no PPL-HMA (N=1139) over 4-years in eyes with no, mild, moderate or severe NPDR were 14.4%(34) vs 5.53% (74), p<0.0001 for the composite outcome; 8.1%(19) vs 4.1%(55), p=0.0083 for ≥2-step progression; 10.2%(24) vs 2.3% (31), p<0.0001 for PDR development; and 4.7%(11) vs 1.9%(25), p=0.0081 for intravitreal injections. Findings remained significant after correcting for diabetes duration, hemoglobin A1c and DR severity.

Conclusions : A fully automated HMA detection algorithm identified PPL-HMA in 20% of eyes and was associated with a 2-3 fold increased risk of DR progression, development of PDR and receipt of intravitreal injections independent of diabetes duration, baseline DR severity and HbA1c levels over 4 years. These findings suggest that the automated evaluation for PPL might assist in predicting future DR risks.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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