Purpose: To determine whether the hyporeflective areas in the blue images obtained by widefield scanning laser ophthalmoscopy (SLO) correspond to the non-perfused areas (NPAs) in the fluorescein angiograms (FA) in eyes with diabetic retinopathy (DR). Design: Retrospective observational case series. Methods: Ninety patients with diabetes mellitus (DM) were studied. All had undergone multicolor widefield SLO imaging. The NPAs in the FA images and hyporeflective areas in the blue widefield SLO images were examined. The morphology of the retina was determined by optical coherence tomography. Results: Hyporeflective areas in the blue SLO images were found with a rate of 76.6% in eyes with proliferative DR eyes. In a comparison of the hyporeflective areas of the blue SLO images to the non-perfused areas in the FA images, the appearance and the correspondence in the locations of these two types of images were found, and the rate was highly concordant with a Cohen's kappa value of 0.675. Conclusions: The high concordance between the hyporeflective areas in the widefield blue SLO and the NPAs in the FA indicates that widefield blue SLO can be used to identify ischemic retinal areas in eyes with DR without the intravenous injection of any dye.

Diabetic retinopathy (DR) is one of the leading causes of blindness worldwide. The retinal ischemic changes in DR need to be detected and treated appropriately to prevent further progression. At present, fluorescein angiography (FA) is the most commonly used method to detect the ischemic areas.　We present our results that showed a practical method of detecting retinal ischemic area covering mid-peripheral retina by multicolor widefield scanning laser ophthalmoscopy (SLO) without fluorescein. Ninety patients with and 50 patients without diabetes mellitus were studied retrospectively. All had undergone multicolor widefield SLO imaging. Hyporeflective areas in blue image of SLO were found in the incidence of 76.6% in eyes with proliferative DR eyes.　In a comparison of the hyporeflective areas of the blue SLO images to the non-perfused areas in the FA images, the appearance and the correspondence in the locations of these findings in the two types of images were found, and the incidence were highly concordant with Cohen kappa value of 0.785. The high concordance between the hyporeflective areas in the wide-field blue SLO images and the NPAs in the FA images indicates that this method can be clinically useful to identify ischemic retinal areas in DR.