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Sean Baluyot, Muhammad Hassan, Muhammad Sohail Halim, Rubbia Afridi, Nam V. Nguyen, Yasir Jamal Sepah; Can Fundus Photograph Montage Replace the Standard 7-Field Stereo Images for Diabetic Retinopathy Severity Scale Assessments?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1691. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To validate the use of fundus photograph (FP) montage images for grading diabetic retinopathy (DR) severity by comparing the agreement between 7-field stereo images and FP montage images
Seven-field stereo images and FP montage images (Fig. 1A) from 75 visits were included in the study. The montage images were developed using Adobe® Photoshop® CS6. The best quality image of each stereo pair was selected and placed on a 150 x 125-inch canvas field according to the standard location from field 1 through 7. All the fields were aligned following the vessels and overlaid using the built-in blending tool. The resulting montage was utilized for grading (Fig. 1B). A 9-step Early treatment of diabetic retinopathy severity (ETDRS) DR severity scale was utilized in this study. Each grader assessed the DR severity levels on masked 7-field stereo and montage images at different time points to remove recall bias. The DR severity score on 7-field stereo image was compared to its counterpart on FP montage image for each grader. Severity level agreement was cross-tabulated and the agreement of DR severity levels between 7-field stereo images and montage images was analyzed using (Kappa) κ intergrader agreement; statistical significance was set at p<0.05.
75 montage images and the corresponding 7-field stereo images were analyzed. The median DR severity score was moderately severe non-proliferative diabetic retinopathy on both 7-field stereo and FP montage images. Table 1 shows the cross tabulation between DR severity score as assessed by 7-field stereo and FP montage images. There was a substantial agreement between the DR severity score as assessed by 7-field stereo images and FP montage images (K= 0.69, Kweighted = 0.80 (p<0.0001). There was complete agreement in 75.3% of the cases. Whereas 95.89% and 100% of the cases had agreement within 1-step and 2-step, respectively.
FP montage images are comparable to standard 7-field stereo images for assessment of DR severity as assessed by the ETDRS severity scale and can be used in place of 7 field stereo images to assess DR severity.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Table 1. Early Treatment of Diabetic Retinopathy Study Diabetic Retinopathy Severity Score Assigned from Grading 7-Field Stereo and FP Montage Images
Figure 1. Standard 7-Field Stereo Images (A) and Fundus Photograph Montage Image (B) showing Moderately Severe DR severity score
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