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Comparison of quantitative assessment and efficiency of diabetic retinopathy diagnosis using ETDRS seven-field imaging and two ultra-widefield imaging

Eye volume 37, pages 3558–3564 (2023)Cite this article

Subjects

Abstract

Purpose

This study compared the efficiency of diabetic retinopathy (DR) diagnosis and differences in the relative visible retinal area among the Early Treatment Diabetic Retinopathy Study (ETDRS) seven-field, ultra-widefield (UWF)-Optos, and UWF-Clarus fundus imaging methods.

Methods

This was a prospective and clinic-based comparative study. All patients underwent three fundus examinations, and all images were graded using the ETDRS severity scale. We compared and analysed the agreement of DR severity and the relative visible retinal area among the three fundus examination methods, and the number and type of lesions outside the ETDRS seven-field (peripheral lesions) between the two UWF imaging methods.

Results

A total of 202 patients (386 eyes) were included. Weighted kappa for the agreement between ETDRS seven-field and blinded Optos images was 0.485; between ETDRS seven-field and blinded Clarus images, 0.924; and between blinded Optos and Clarus images, 0.461. Blinded Clarus showed excellent performance when a ETDRS scale was used for grading the images. The relative visible retinal area for ETDRS seven-field images was 195 ± 28 disc area (DA); single Optos images, 371 ± 69 DA; single Clarus images, 261 ± 65 DA; two-montage Clarus images, 462 ± 112 DA; and four-montage Clarus images, 598 ± 139 DA. The relative visible retinal area was statistically significant between any two of the imaging systems used. In total, 2015 and 4200 peripheral lesions were detected in single Optos and Clarus images, respectively (P < 0.001). These peripheral lesions on two UWF images suggested a more severe DR level in approximately 10% and 12% of eyes, respectively.

Conclusion

UWF-Clarus fundus imaging offers a suitable assessment approach for DR severity; it could improve DR diagnosis and has the potential to replace ETDRS seven-field imaging after additional clinical trials.

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Fig. 1: Three fundus imaging modalities.
Fig. 2: Grading agreement on DR severity based on the ETDRS scale.
Fig. 3: Comparison of the relative visible retinal area.
Fig. 4: Distribution of peripheral lesions of single Optos and Clarus imaging.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Henan Eye Institute.

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Acknowledgements

The authors thank all the patients who participated in this study.

Funding

This study was supported by Basic Research Project of Henan Eye Research Institute (20JCZD001, 21JCQN003), Key Research and Development of Henan Province (192102310075), Joint Project of Medical Science and Technology of Henan Province (SBGJ2018080, LHGJ20220088).

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Authors and Affiliations

  1. Henan Provincial People’s Hospital, Henan Eye Institute, Henan Eye Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, No. 7 Weiwu Road, Zhengzhou, 450000, Henan, China

    Yuanyuan Xiao, Zixu Huang, Qiongqiong Yuan, Xiaofeng Du, Zeyu Li, Xiaodong Nie, Qianqian Shi, Handong Dan & Zongming Song

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Contributions

Concept and design: ZS; Acquisition, analysis, or interpretation of data: YX, ZH, QY, XD, ZL, XN, QS. Drafting of the manuscript: YX; Critical revision of the manuscript: HD; Statistical analysis: HD; Administrative, technical, or material support: YX, ZS.

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Correspondence to Handong Dan or Zongming Song.

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Xiao, Y., Huang, Z., Yuan, Q. et al. Comparison of quantitative assessment and efficiency of diabetic retinopathy diagnosis using ETDRS seven-field imaging and two ultra-widefield imaging. Eye 37, 3558–3564 (2023). https://doi.org/10.1038/s41433-023-02549-1

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