June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Disparity of microaneurysm count between ultrawide field color imaging (UWF-CI) and ultrawide field fluorescein angiography (UWF-FA) in eyes with diabetic retinopathy
Author Affiliations & Notes
  • Mohamed Ashraf Elmasry
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
  • Konstantina Sampani
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Omar Mohammed Abdelal
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Alan Fleming
    Optos PLC, United Kingdom
  • Ahmed Souka
    Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
  • Samir Elbaha
    Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
  • Paolo S Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • 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   Mohamed Elmasry, None; Konstantina Sampani, None; Omar Abdelal, None; Alan Fleming, Optos Plc (E); Ahmed Souka, None; Samir Elbaha, None; Paolo Silva, Hill-Ron (C), Optomed Oy (F), Optos (F); Jennifer Sun, None; Lloyd Aiello, Kalvista (I), Kalvista (C), Novo Nordisk (C), Optos (F), Optos (R)
  • Footnotes
    Support  Massachusetts Lions Eye Research Fund, Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5306. doi:
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    • Get Citation

      Mohamed Ashraf Elmasry, Konstantina Sampani, Omar Mohammed Abdelal, Alan Fleming, Ahmed Souka, Samir Elbaha, Paolo S Silva, Jennifer K Sun, Lloyd P Aiello; Disparity of microaneurysm count between ultrawide field color imaging (UWF-CI) and ultrawide field fluorescein angiography (UWF-FA) in eyes with diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5306.

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

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Abstract

Purpose : To determine equivalence of manual microaneurysm (MA) counts on UWF-CI and UWF-FA.

Methods : Retrospective study of all patients at the Joslin Diabetes Center from 3/21/2012-12/21/2018 with type 1 or 2 diabetes and both UWF-FA and UWF-CI performed in the same eye within a 2-wk period. MAs were manually counted in individual ETDRS and extended UWF zones on both UWF-FA and UWF-CI. Fields with ≥ 20 MAs were used to assign DR severity per international classification system (0 fields=mild, 1-3=moderate, ≥4=severe). UWF-CI and UWF-FA MA count agreement and effect on DR severity were evaluated.

Results : In 288 eyes (193 patients), UWF-CI DR severity was 2.4% no DR, 29.9% mild, 32.6% moderate, 22.9% severe NPDR and 12.2% PDR. UWF-FA MA counts were 3.5x higher than UWF-CI counts overall (414.4±375.2 vs 120.0±157.4,p<0.001), 3.2x higher in ETDRS fields (265.8±239.5 vs 81.8±100.1,p<0.001) and 5.3x higher in extended ETDRS fields (148.6±184.6 vs 28.2±74.8,p<0.001). In eyes with NPDR on UWF-CI (N=246), UWF-FA images had 2.3x more fields with ≥20 MAs than UWF-CI in the ETDRS fields and 2.0x more in all total fields (p<0.001), with only fair agreement between modalities (k=0.325,0.313). In ETDRS fields, agreement for DR severity based on MA counts increased from k=0.346 to 0.600 when dividing UWF-FA counts by a factor of 3 and declined rapidly in agreement thereafter. Total ultrawide field DR severity agreement increased from k=0.317 to 0.565 with an adjustment factor of 4-5. UWF-FA with MA counts ≥20 were compared to DR severity determined by formal ETDRS grading of UWF-CI. Within the ETDRS fields, kappa agreement increased from 0.543 uncorrected to 0.643 when adjusting by a factor of 2 followed by a rapid decline thereafter. Highest agreements with formal ETDRS grading were observed with total UWF-CI MA count (k=0.656), UWF-FA ETDRS counts at threshold=2 (k=0.643) and UWF-FA total field counts at threshold=4 (k=0.584).

Conclusions : UWF-FA detects 3.2-5.3x more MAs and 2.0-2.3x more fields with MAs≥20 than UWF-CI at all DR severity levels, thus limiting direct comparison between these modalities. Correcting UWF-FA MA counts can substantially improve agreement between UWF-FA and UWF-CI derived DR severity and should be considered when using UWF-FA MA counts to assess DR outcomes.

This is a 2020 ARVO Annual Meeting abstract.

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