Hemorrhage and/or Microaneurysm Severity and Count in Ultrawide Field Images and Early Treatment Diabetic Retinopathy Study Photography.
To evaluate detection of hemorrhage and/or microaneurysm (H/Ma) using ultrawide field (UWF) retinal imaging as compared with standard Early Treatment Diabetic Retinopathy Study (ETDRS) 7-field photographs (ETDRS photos).



Single-site comparative study of UWF images and ETDRS photos.



One hundred twenty-six eyes of 69 patients with no diabetic retinopathy (DR) or mild or moderate nonproliferative DR (NPDR).



Stereoscopic 200° UWF images and stereoscopic 35mm 30° 7-field color photographs were acquired on the same visit. Images were graded for severity and distribution of H/Ma. H/Mas were counted in ETDRS fields 2 to 7 in both ETDRS photos and UWF images. H/Mas in the UWF peripheral fields were also counted.



Kappa (κ) and weighted κ statistics for agreement. Number of H/Ma within and outside ETDRS fields identified in UWF images and ETDRS photos.



Distribution of DR severity by ETDRS photos was 24 (19.0%) no DR, 48 (38.1%) mild NPDR, and 54 (42.9%) moderate NPDR. A total of 748 of 756 fields (98.9%) were gradable for H/Mas on ETDRS photos and UWF images. Simple κ/weighted κ statistics for severity of H/Ma: all fields 0.61/0.69, field 2 0.70/0.77, field 3 0.62/0.73, field 4 0.50/0.62, field 5 0.54/0.65, field 6 0.64/0.70, and field 7 0.58/0.63 with overall exact agreement in 81.3% and within 1 step in 97.9% of fields. A greater proportion of fields was graded a more severe H/Ma level in UWF images than in the corresponding ETDRS photos (UWF: 12.7% vs.



6.5%). Evaluating comparable areas in UWF images and ETDRS photos (fields 2-7), a mean of 42.8 H/Mas were identified using ETDRS photos and 48.8 in UWF images (P = 0.10). An additional mean of 21.3 H/Mas (49.8% increase, P < 0.0001) were identified in the peripheral fields of the UWF images.



There is good to excellent agreement between UWF images and ETDRS photos in determining H/Ma severity, with excellent correlation of H/Ma counts within ETDRS photo fields. UWF peripheral fields identified 49.8% more H/Ma, suggesting a more severe H/Ma in 12.7% of eyes. Given the additional lesions detected in peripheral fields and the known risks associated with H/Ma and peripheral lesions, quantification of H/Ma using UWF images may provide a more accurate representation of DR disease activity and potential greater accuracy in predicting DR progression.
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, National Institutes of Health, University of the Philippines, Manila, Philippines. Electronic address: paoloantonio.silva@joslin.harvard.edu.
Paolo S
PS
Silva
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Hala
H
El-Rami
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Rasha
R
Barham
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Aditi
A
Gupta
Optos plc, Dunfermline, Scotland, United Kingdom.
Alan
A
Fleming
Optos plc, Dunfermline, Scotland, United Kingdom.
Jano
J
van Hemert
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Jerry D
JD
Cavallerano
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Jennifer K
JK
Sun
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Lloyd Paul
LP
Aiello
D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D000071071:Microaneurysm / Q000175:diagnosis* / Q000209:etiology; D010781:Photography / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012160:Retina / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D012720:Severity of Illness Index; D013997:Time Factors