July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Comparison of Diabetic Retinopathy (DR) Severity Identified on Ultrawide Field Retinal Images (UWF-RI) and Ultrawide Field Fluorescein Angiograms (UWF-FA)
Author Affiliations & Notes
  • Omar Abdelal
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Mohamed Ashraf Elmasry
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Siamak Shokrollahi
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Joanne Rocha
    Department of Ophthalmology, The Medical City, Ortigas Avenue, Pasig City, Philippines
  • Milagros Herrera Arroyo
    Department of Ophthalmology, The Medical City, Ortigas Avenue, Pasig City, Philippines
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Omar Abdelal, None; Mohamed Elmasry, None; Siamak Shokrollahi, None; Joanne Rocha, None; Milagros Arroyo, None; Jennifer Sun, None; Lloyd Aiello, kalVista Pharmaceuticals (I), kalVista Pharmaceuticals (C), Mingsight (C), Novo Nordisk (C), Optos (R), Retinal Solutions (C); Paolo Silva, Optos, plc (F), Welch Allyn, Inc (F)
  • Footnotes
    Support  Massachusetts Lions’ Eye Research Fund, Balik-Scientist Program of the Depatment of Science and Technology, Republic of the Philippines
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1571. doi:
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      Omar Abdelal, Mohamed Ashraf Elmasry, Siamak Shokrollahi, Joanne Rocha, Milagros Herrera Arroyo, Jennifer K Sun, Lloyd P Aiello, Paolo Sandico Silva; Comparison of Diabetic Retinopathy (DR) Severity Identified on Ultrawide Field Retinal Images (UWF-RI) and Ultrawide Field Fluorescein Angiograms (UWF-FA). Invest. Ophthalmol. Vis. Sci. 2019;60(9):1571.

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

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Abstract

Purpose : To compare DR severity identified on UWF-RI with UWF-FA.

Methods : Images were acquired using mydriatic phase-plate adjusted 200° UWF-RI and UWF-FA of 200 eyes of 100 patients with no prior panretinal laser and non-DR retinal vascular disease. Stereographically projected images were evaluated for DR lesions and ETDRS DR severity at a centralized reading center. Presence of predominantly peripheral lesions (PPL) in each peripheral retinal field was determined. Sensitivity (SN) and specificity (SP), simple (K) and linear weighted (KW) kappa statistics were evaluated.

Results : Distribution of DR severity for UWF-RI vs UWF-FA was: no DR 14% vs 1.5%; mild nonproliferative DR (NPDR) 15% vs 20%; moderate 44% vs 30%; severe 15.5% vs 34%; proliferative DR (PDR) 8.5% vs 11%; and high-risk PDR 3% vs 3.5%. Overall agreement of UWF-RI and UWF-FA for DR severity was K=0.46 and Kw=0.69. DR severity agreement between UWF-RI and UWF-FA images was <1-step in 97% of eyes and exact in 58%. No eye had more severe DR graded on UWF-RI than on UWF-FA. Compared to UWF-RI, UWF-FA identified 1-step more severe DR in 39% and 2-step more severe DR in 6 (3%) with no discrepancy greater than 2 steps. Among eyes with PDR by UWF-FA (N =29), 6 (21%) were not identified as having PDR on UWF-RI [SN=0.79 (CI 0.60-0.91), SP=1.00 (0.97-1.0)]. Among eyes with severe NPDR or PDR by UWF-FA (N =97), 43 (44%) were identified as less than severe on UWF-CR [SN=0.56 (0.45-0.65), SP=1.00 (0.95-1.0)]. Conversely among eyes with no to mild NPDR on UWF-RI (N=58), 15 (26%) had more severe DR on UWF-FA [SN=0.74 (0.61-0.84), SP=1.00 (0.96-1.0)].

Conclusions : UWF-FA identifies substantially more severe DR than observed using UWF-RI. However, in this cohort, differences of 2-steps were rare and there were no differences >2 steps. Further study is needed to determine if those with more severe DR by UWF-FA are at higher risk of progression than suggested by UWF-RI and whether these findings add significant clinical utility.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

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