Abstract
BackgroundThe ETDRS stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials. To the best of our knowledge, the comparison between montage and stereoscopic 7F has not been reported in the literature. Therefore, the main purpose of this study is to compare agreement between montage and stereoscopic seven-field (7F) photographs in the assessment of DR severity.MethodsStereoscopic 7F photographs were captured from subjects with DR. Montages of monoscopic 7F images were created using Adobe Photoshop CS6 Extended©. The best quality image of each stereo pair was selected and placed on a 150 × 125-inch canvas field according to the standard location from field 1 to 7. All the fields were aligned following the vessels and overlaid using the built-in blending tool. The resulting montage was utilized for grading and compared with grading on stereoscopic 7F photographs. Three independent graders were asked to assess DR severity on stereoscopic 7F photographs and montage. Severity level agreement between stereo 7F and montage was cross-tabulated and the agreement of DR severity levels between stereoscopic 7-field images and montage was analyzed using κ intergrader agreement; statistical significance was set at p < 0.05.ResultsA total of 50 eyes were included in the study. There was a substantial agreement between stereoscopic 7F and montage (κ = 0.745, κweighted = 0.867) in assessment of DR severity. Of 50 eyes, 80% of the cases showed complete agreement, and 100% of the cases had agreement within one-step. There was a moderate agreement among graders, and κ-value ranged from 0.4705 to 0.5803.ConclusionIn this study, we found a substantial agreement in assessing DR severity score employing non-stereoscopic montage and stereoscopic 7F photographs.
Highlights
The Early Treatment Diabetic Retinopathy Study (ETDRS) stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials
The distribution of DR severity level assessed by stereoscopic 7F photographs was level 10 (0 eye); level 14/15/20 (0 eye); level 35 (6 eyes); level 43 (11 eyes); level 47 (13 eyes); level 53 (7 eyes); and level ≥ 60 (13 eyes)
There was a substantial agreement between stereoscopic 7F and montage (κ = 0.745, κweighted = 0.867, p < 0.0001) in the assessment of DR severity score
Summary
The ETDRS stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials. In assessing DR severity, the perception of depth is generally presumed to: (1) help to differentiate neovascularization from intraretinal microvascular abnormalities (IRMA); (2) detect pre-retinal and vitreous hemorrhage; and (3) identify presence of macular edema. Despite these advantages, acquiring and grading stereoscopic 7F photographs are time-consuming, and highly dependent on the experiences of graders and training of photographers [15, 16]. Previous study showed that stereoscopic effect may not be critical for the assessment of DR severity [17]
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