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Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment

OBJECTIVES: To compare the diabetic retinopathy (DR) severity level determined when considering only the ETDRS 7-field region versus the entire ultrawidefield (UWF) image. METHODS: In this retrospective, cross-sectional study, UWF pseudocolor images were graded on the Eyenuk image viewing, grading,...

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Autores principales: Attiku, Yamini, Nittala, Muneeswar Gupta, Velaga, Swetha B., Ramachandra, Chaithanya, Bhat, Sandeep, Solanki, Kaushal, Jayadev, Chaitra, Choudhry, Netan, Orr, Samantha Miyoko Ashlyn, Jiang, Shangjun, He, Ye, Sadda, SriniVas R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10517125/
https://www.ncbi.nlm.nih.gov/pubmed/37165011
http://dx.doi.org/10.1038/s41433-023-02445-8
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author Attiku, Yamini
Nittala, Muneeswar Gupta
Velaga, Swetha B.
Ramachandra, Chaithanya
Bhat, Sandeep
Solanki, Kaushal
Jayadev, Chaitra
Choudhry, Netan
Orr, Samantha Miyoko Ashlyn
Jiang, Shangjun
He, Ye
Sadda, SriniVas R.
author_facet Attiku, Yamini
Nittala, Muneeswar Gupta
Velaga, Swetha B.
Ramachandra, Chaithanya
Bhat, Sandeep
Solanki, Kaushal
Jayadev, Chaitra
Choudhry, Netan
Orr, Samantha Miyoko Ashlyn
Jiang, Shangjun
He, Ye
Sadda, SriniVas R.
author_sort Attiku, Yamini
collection PubMed
description OBJECTIVES: To compare the diabetic retinopathy (DR) severity level determined when considering only the ETDRS 7-field region versus the entire ultrawidefield (UWF) image. METHODS: In this retrospective, cross-sectional study, UWF pseudocolor images were graded on the Eyenuk image viewing, grading, and annotation platform for the severity of DR considering only the regions within the ETDRS 7-fields as well as the entire UWF image using two different protocols: 1) the simple International Classification of Diabetic Retinopathy (ICDR) scale and 2) the more complex DRCR.net Protocol AA grading scale. RESULTS: A total of 250 eyes from 157 patients were included in this analysis. Six eyes (2.4%) demonstrated a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ICDR classification system. The discrepancies were due to the presence of lesions [intraretinal haemorrhage (n = 2), neovascular disease (n = 4)] in the peripheral fields which were not identified in the ETDRS 7-fields. Fourteen eyes (5.6%) had a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ETDRS DRSS Protocol AA grading scale. The discrepancies were due to the presence of a higher level of disease [intraretinal haemorrhage (n = 4), neovascularization (n = 4), preretinal haemorrhage (n = 2), scatter laser scars (n = 4)] in the peripheral fields. CONCLUSION: Although considering regions outside of the ETDRS 7-fields altered the DR severity level assessment in <5% of cases in this cohort, significant and potentially vision-threatening lesions including neovascularization and preretinal haemorrhage were identified in these peripheral regions. This highlights the importance of evaluating the entire UWF region when assessing patients with diabetic retinopathy.
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spelling pubmed-105171252023-09-24 Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment Attiku, Yamini Nittala, Muneeswar Gupta Velaga, Swetha B. Ramachandra, Chaithanya Bhat, Sandeep Solanki, Kaushal Jayadev, Chaitra Choudhry, Netan Orr, Samantha Miyoko Ashlyn Jiang, Shangjun He, Ye Sadda, SriniVas R. Eye (Lond) Article OBJECTIVES: To compare the diabetic retinopathy (DR) severity level determined when considering only the ETDRS 7-field region versus the entire ultrawidefield (UWF) image. METHODS: In this retrospective, cross-sectional study, UWF pseudocolor images were graded on the Eyenuk image viewing, grading, and annotation platform for the severity of DR considering only the regions within the ETDRS 7-fields as well as the entire UWF image using two different protocols: 1) the simple International Classification of Diabetic Retinopathy (ICDR) scale and 2) the more complex DRCR.net Protocol AA grading scale. RESULTS: A total of 250 eyes from 157 patients were included in this analysis. Six eyes (2.4%) demonstrated a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ICDR classification system. The discrepancies were due to the presence of lesions [intraretinal haemorrhage (n = 2), neovascular disease (n = 4)] in the peripheral fields which were not identified in the ETDRS 7-fields. Fourteen eyes (5.6%) had a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ETDRS DRSS Protocol AA grading scale. The discrepancies were due to the presence of a higher level of disease [intraretinal haemorrhage (n = 4), neovascularization (n = 4), preretinal haemorrhage (n = 2), scatter laser scars (n = 4)] in the peripheral fields. CONCLUSION: Although considering regions outside of the ETDRS 7-fields altered the DR severity level assessment in <5% of cases in this cohort, significant and potentially vision-threatening lesions including neovascularization and preretinal haemorrhage were identified in these peripheral regions. This highlights the importance of evaluating the entire UWF region when assessing patients with diabetic retinopathy. Nature Publishing Group UK 2023-05-10 2023-10 /pmc/articles/PMC10517125/ /pubmed/37165011 http://dx.doi.org/10.1038/s41433-023-02445-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Attiku, Yamini
Nittala, Muneeswar Gupta
Velaga, Swetha B.
Ramachandra, Chaithanya
Bhat, Sandeep
Solanki, Kaushal
Jayadev, Chaitra
Choudhry, Netan
Orr, Samantha Miyoko Ashlyn
Jiang, Shangjun
He, Ye
Sadda, SriniVas R.
Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment
title Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment
title_full Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment
title_fullStr Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment
title_full_unstemmed Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment
title_short Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment
title_sort comparison of diabetic retinopathy severity grading on etdrs 7-field versus ultrawide-field assessment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10517125/
https://www.ncbi.nlm.nih.gov/pubmed/37165011
http://dx.doi.org/10.1038/s41433-023-02445-8
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