Abstract
Ultrawide field imaging (UWF) has allowed the visualization of a significantly greater area of the retina than previous standard approaches. In diabetic retinopathy (DR), significantly more lesions are seen on UWF imaging compared to the seven-standard ETDRS fields. In addition, some eyes have lesions that are located predominantly in the peripheral retina that are associated with an increased risk of DR progression. The current DR severity scales are still largely based on clinically visible retinal microvascular lesions and do not incorporate retinal periphery, neuroretinal, or pathophysiologic changes. Thus, current scales are not well suited for documenting progression or regression in eyes with very early or advanced DR, nor in the setting of vascular endothelial growth factor inhibitors (antiVEGF). In addition, the categorical system is highly subjective, and grading is variable between different graders based on experience level and training background. Recently, there have been efforts to quantify DR lesions on UWF imaging in an attempt to generate objective metrics for classification, disease prognostication and prediction of treatment response. The purpose of this review is to examine current quantitative metrics derived from UWF fluorescein angiograms and UWF color imaging to determine their feasibility in any potential future DR classification.
Highlights
In 2019, an expert panel defined ultrawide field imaging (UWF) as images showing retinal anatomic features anterior to the vortex vein ampullae in all four quadrants [1].UWF imaging allows the visualization of a substantially greater area of the retina compared to the standard seven field Early Treatment Diabetic Retinopathy Study (ETDRS) fields (82% vs. 30%) (Figure 1) [2,3]
The current review this review is to examine current quantitative metrics derived from only UWF-fluorescein angiography (FA) and UWF-color images (CI) to determine their feasibility in any potential future diabetic retinopathy (DR) classification
It is still unknown if incorporating H/Ma counts from UWF images can improve prediction and determine which eyes are at increased risk of developing proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME)
Summary
In 2019, an expert panel defined ultrawide field imaging (UWF) as images showing retinal anatomic features anterior to the vortex vein ampullae in all four quadrants [1]. One possible sion [11] This proposed scale might incorporate information from complex approaches addition to this classification could include quantitative metrics derived from UWF imagand novel features on retinal images that are not detectable by human grading. Previous studies looking at central retinal fields did not identify a robust association between H/Ma counts and DR progression [14,15] It is still unknown if incorporating H/Ma counts from UWF images can improve prediction and determine which eyes are at increased risk of developing proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME). Quantitative H/Ma counts determined that on average UWF images identified 21.3 more H/Ma in the peripheral extended fields compared to the ETDRS fields, representing an approximate 50% increase in the total counts per eye [22]. It will be important in future studies to determine which of these methods for quantifying PPL is more accurate and, more importantly, which is more highly associated with future DR progression in a prospective, longitudinal cohort
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