Aiello LP, et al. - Authors compared the diabetic retinopathy (DR) severity from modified ETDRS 7-field imaging and ultrawide-field (UWF) imaging. When determining the severity of DR within the 7 standard fields, moderate to substantial agreement of imaging by the ETDRS 7-field and UWF imaging systems was noted. Findings suggested the equivalent distribution of disparities in an individual eye between imaging modalities and these can be better or worse on 1 or the other.

Methods

• Researchers conducted a preplanned, cross-sectional analysis which included modified ETDRS 7-field images obtained using the Diabetic Retinopathy Clinical Research Network acquisition protocol and UWF images obtained captured with the Optos 200Tx system (Optos, PLC) from adult participants (≥18 years old) with type 1 or type 2 diabetes.
• They evaluated both image types by trained graders masked to clinical data.
• From February 2015 to December 2015, data collection occurred, and from June 2016 to December 2017, data analysis was done.
• They calculated the agreement between UWF images, UWF imagesmasked to include only the ETDRS 7-field area, and ETDRS 7-field images using κ statistics.

Results

• As per data, they included a total of 764 eyes from 385 participants; participants had a median (IQR) age of 62.2 (53.6-69.2) years, 194 (50.4%) were women, and 256 (66.5%) were white.
• Findings suggested that out of 742 eyes with both ETDRS 7-field images and UWF masked images graded, 359 (48.4% [95% CI, 44.4%-52.4%]) eyes had exact agreement, and 653 eyes (88.0% [95% CI, 85.2%-90.3%]) agreed within 1 step (weighted κ, 0.51 [95% CI, 0.44-0.58]).
• Perfect agreement was found in 435 eyes (59.0% [95% CI, 55.1%-62.8%]) and agreement within 1 step in 714 eyes (96.9% [95% CI, 95.1%-98.0%]; κ, 0.77 [95% CI, 0.73-0.82]) after open adjudication by an independent senior grader of all images with more than a 2-step discrepancy.
• In 59 eyes (50.9% [95% CI, 41.3%-60.4%]), ability of the imaging modalities to detect retinopathy severity in an individual eye was considered similar, it was considered better for ETDRS 7-field imaging in 22 eyes (19.0% [95% CI, 12.5%-27.7%]), and better for UWF-masked images in 31 eyes (26.7% [95% CI 18.8%-36.5%]).
• Results demonstrated that 94 of 751 eyes (12.5%) revealed DR at least 1 step more severe on UWF unmasked images vs UWF masked images when comparing UWF masked and unmasked images.
• In 308 of 751 eyes (41.0%), peripheral DR lesions were predominantly present ; this suggested increased DR severity by 2 or more steps in 34 eyes (11.0%).