Purchase this article with an account.
Yamini Attiku, Muneeswar Gupta nittala, Ye He, Swetha Bindu Velga, Chaitanya Ramachandra, Sandeep Bhat, Kaushal Solanki, Chaitra Jayadev, Netan Choudhry, Srinivas R Sadda; Comparison of Diabetic Retinopathy Severity Grading on ETDRS 7-field versus Ultrawide field Assessment. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2178 – F0241.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare the diabetic retinopathy severity level determined when considering only the ETDRS 7-Field region versus the entire ultrawide field (UWF) image
In this retrospective, cross-sectional study, UWF images (Optos 200Tx) were obtained from diabetic patients presenting to the retina clinic. An ETDRS 7-field overlay was superimposed on these UWF images to define the region covered by the ETDRS 7 standard fields. The images were graded on Eyenuk's web-based grading portal for the severity of DR, based on the region within the ETDRS 7-fields as well as based on the entire UWF image, using both the ICDR severity scale and the modified ETDRS DRSS scale from DRCR.net Protocol AA. In addition, the grader also determined whether the lesions were predominantly central lesions (PCL) or predominantly peripheral lesions (PPL) using both a single-field (PPL was assigned if any one peripheral field had more lesions than the corresponding ETDRS field) method and a global method (if entire region outside ETDRS 7-fields had more lesions than within ETDRS 7-fields).
A total of 125 eyes from 81 patients were included in this analysis. The distribution of DR severity levels as assessed by ICDR is shown in Table 1, and by ETDRS DRSS in Table 2. Only 3 (2.4%) eyes had a discrepancy in DR severity level between the ETDRS 7-field region and the entire UWF region when using the ICDR classification system. Six (4.8%) eyes had a discrepancy in DR severity level between the ETDRS 7-field region and the entire UWF region when using the ETDRS DRSS Protocol AA classification system. The discrepancy was due to the presence of lesions [hemorrhages (n=1), neovascularization (n=2), scatter laser scars (n=2), and pre-retinal hemorrhage (n=1)] in the peripheral fields which were not identified in the ETDRS 7-fields. Thirty percent of the eyes were PPL by the single-field method and 10.5% were PPL by the global method.
Although, considering regions outside of the ETDRS 7-fields altered the DR severity level assessment in < 5% of cases in this cohort (which only had a proportion of patients with PPL), significant potential vision-threatening lesions including neovascularization and pre-retinal hemorrhage were missed. This highlights the importance of evaluating the entire UWF region when assessing patients with diabetic retinopathy.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
This PDF is available to Subscribers Only