New vessels detected on wide-field imaging compared to two-field and seven-field imaging: implications for diabetic retinopathy screening image analysis

Abstract

IntroductionWide-field retinal imaging (Optomap), used for detecting diabetic retinopathy (DR), has been shown to compare well with seven-field early treatment diabetic retinopathy study (ETDRS) photographs. An Optomap 200° image covers 80% of the retinal surface, compared with the standard seven-field, 30° images, covering 30% of the retinal surface. In England, DR screening is performed by grading two, 45° images per eye, by the DR screening service (DRSS).PurposeTo assess how often retinal new vessels (NVs) are observed on Optomap imaging, outside the DRSS two fields and standard seven-field photography, in a cohort of patients referred by the DRSS.MethodA consecutive series of treatment naïve patients with DR, referred from DRSS with pre-proliferative or proliferative DR or diabetic maculopathy, were imaged with Optomap colour images, within 3 months of DRSS referral. The incidence and distribution of NVs were recorded in relation to two-field and seven-field areas.ResultsNVs were found in 102 of 1562 treatment naïve eyes (6.5%) of 781 patients. Of these, 72 were referred from DRSS as having NVs, but an additional 30 eyes (29% of NVs detected) from 25 patients were referred with a lesser degree of DR. In 25 of the 30 eyes without NVs reported on referral, NVs were located outside the standard two fields taken at DRSS, and in 12, NVs were outside the area covered on seven-field imaging (11.7% of eyes with NVs).ConclusionsWide-field imaging with Optomap detected approximately 30% more NVs than standard two-field imaging in patients referred from a UK DRSS.

Protecting Vision in Patients With Diabetes With Ultra-Widefield Imaging: A Review of Current Literature

“…Several level 4 studies indicate that UWFI has good DR severity agreement with 7SF ETDRS and NMFP and moderate agreement with DFE, and thus can be a sufficient imaging modality to screen and diagnose DR. 14,15,[20][21][22] UWFI also shows promising utility in long-term management of DR, as new biomarkers of DR pathology can be documented "outside," "anterior," or "peripheral" to the border of 7SF ETDRS. [23][24][25][26][27]29 UWFI appears to have similar or higher rates of DR detection as reported by five level 4 studies 14,15,19,20,16 when compared to the gold standard of DR diagnosis, 7SF ETDRS. This affirms UWFI use as a diagnostic tool for DR in place of traditional fundus imaging systems.…”

“…Bae et al also reported that the incidence of anterior DR was correlated with lower hemoglobin A1C levels (7.03% in anterior DR versus 7.99% in posterior DR) and higher high density lipoprotein levels (51.2 mg/dL in anterior DR versus 49.7 mg/dL in posterior DR). 23 Two prospective, cross-sectional studies 20,25 reported that 10.7% and 11.7% were additional cases of DR found by UWFI.…”

Comparing diabetic retinopathy lesions in scanning laser ophthalmoscopy and colour fundus photography

“…; Price & Au ; Talks et al. ). Price in 2015 showed 15% of eyes were diagnosed with more severe diabetic retinopathy when using SLO when compared to ETDRS 7F view (Price & Au ).…”

“…Talks detected approximately 30% more NVEs than with standard two‐field imaging used by the UK diabetic retinopathy screening service (Talks et al. ).…”

Does delay in referral of proliferative diabetic retinopathy from the diabetic eye screening programme lead to visual loss?

“…7 Wide-field imaging detects more new vessels in more patients than the standard two 45°images used by the DESP. 8 These differences in diagnosis continue to challenge both graders and ophthalmologists, but can be resolved with a better understanding of the processes in each service and with better communication between them.…”