Abstract
BackgroundThe ability to image wide fundus fields and to conduct swift, non-invasive examinations is increasingly important with the escalation in patients with diabetic retinopathy (DR).MethodsFifty eyes of 28 consecutive patients with DR were examined in this prospective observational study. A total of 46 eyes, 25 right and 21 left eyes, of 27 patients (male, 19; female, 8) were ultimately included in the analysis. All patients underwent comprehensive ophthalmological examination. A single image each was obtained using two ultra-wide-field (UWF) imaging systems: Optos® (Optos Carfornia®, Optos PLC, Dunfermline, United Kingdom) and Clarus™ (CLARUS 500™, Carl Zeiss Meditec Inc., Californea, USA), without mydriasis. The total retinal area captured and the obscured retinal area were compared between the two systems using nonparametric Wilcoxon matched-pairs signed-rank analysis. Early Treatment of Diabetic Retinopathy Study (ETDRS) and International Clinical DR severity were analyzed by κ statistics.ResultsThe Optos® allowed capture of larger areas of the fundus than the Clarus™ (465 ± 117 vs. 243 ± 39 disc areas, P < 0.0001). In 85% (39/46) of Optos® images and 7% (3/46) of Clarus™ images, a slightly obscured area was observed within the ETDRS-7 field area. κ values for ETDRS DR severity and International Clinical DR severity between the Optos® and Clarus™ images were 0.88 and 0.79, respectively. Severity was higher according to Clarus™ images in two eyes in which the ETDRS DR severity grading differed between the systems. Severity was higher in four Clarus™ images and in a single Optos® image in five eyes in which the International Clinical DR severity grading differed between the systems.ConclusionThe Optos® and Clarus™ UWF retinal imaging systems were useful for examining eyes with DR, using single images obtained without mydriasis. The systems were both generally consistent in assessing DR severity, with some partial discrepancies. It is important to understand the characteristics of each respective UWF retinal imaging system when using them to assess DR.
Highlights
The ability to image wide fundus fields and to conduct swift, non-invasive examinations is increasingly important with the escalation in patients with diabetic retinopathy (DR)
Evaluation of obscured retinal area In 85% (39/46) of Optos® images and 7% (3/46) of ClarusTM images, a slightly obscured area was observed within the Early Treatment of Diabetic Retinopathy Study (ETDRS)-7 field area
Severity was higher in four ClarusTM images and in a single Optos® image of five eyes where the results of International Clinical DR severity grading differed between the two imaging systems (Table 3)
Summary
The ability to image wide fundus fields and to conduct swift, non-invasive examinations is increasingly important with the escalation in patients with diabetic retinopathy (DR). Treatment of Diabetic Retinopathy Study (ETDRS) 7-standard field 35-mm color 30° color fundus images (ETDRS 7-field images) have long been the gold standard for the evaluation of DR severity [2]. Irrespective of which classification is used, it is important to acquire wide-field color fundus images in order to evaluate DR accurately and share information among the relevant parties. Since the number of patients with DR is expected to increase [6], and as early detection and intervention is useful for preventing severe vision loss, it is necessary that the examination can be carried out swiftly and with greater convenience
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