title: Ultra-wide-field angiography improves the detection and classification of diabetic retinopathy.
abstract: OBJECTIVE
  To evaluate patients with diabetic retinopathy using ultra-wide-field fluorescein angiography and to compare the visualized retinal pathology with that seen on an overly of conventional 7 standard field (7SF) imaging.
  
  
  METHODS
  Two hundred and eighteen eyes of 118 diabetic patients who underwent diagnostic fluorescein angiography using the Optos Optomap Panoramic 200A imaging system were included. The visualized area of the retina, retinal nonperfusion, retinal neovascularization, and panretinal photocoagulation were quantified by two independent masked graders. The respective areas identified on the ultra-wide-field fluorescein angiography image were compared with an overly of a modified 7SF image as outlined in the Early Treatment Diabetic Retinopathy Study.
  
  
  RESULTS
  Ultra-wide-field fluorescein angiograms imaging, on average, demonstrated 3.2 times more total retinal surface area than 7SF. When compared with 7SF, ultra-wide-field fluorescein angiography showed 3.9 times more nonperfusion (P < 0.001), 1.9 times more neovascularization (P = 0.036), and 3.8 times more panretinal photocoagulation (P < 0.001). In 22 eyes (10%), ultra-wide-field fluorescein angiography demonstrated retinal pathology (including nonperfusion and neovascularization) not evident in an 7SF overly.
  
  
  CONCLUSIONS
  Compared with conventional 7SF imaging, ultra-wide-field fluorescein angiography reveals significantly more retinal vascular pathology in patients with diabetic retinopathy. Improved retinal visualization may alter the classification of diabetic retinopathy and may therefore influence follow-up and treatment of these patients.
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Wessel
authors.forename: Grant D
authors.initials: GD
authors.lastname: Aaker
authors.forename: George
authors.initials: G
authors.lastname: Parlitsis
authors.forename: Minhee
authors.initials: M
authors.lastname: Cho
authors.forename: Donald J
authors.initials: DJ
authors.lastname: D'Amico
authors.forename: Szilárd
authors.initials: S
authors.lastname: Kiss
mesh_terms: D000368:Aged; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods*; D012189:Retrospective Studies