Building upon two previous studies regarding the use of optomap images for studying diabetic retinopathy (DR) where optomap was found to be equivalent to Early Treatment Diabetic Retinopathy Study (ETDRS)¹, and where there was the presence of predominantly peripheral lesions, they were associated with an almost 5-fold risk in the progression of DR over 4 years², a recent study from the American Academy of Ophthalmology concludes that there is a good to excellent agreement between ultra-widefield (UWF™) images and ETDRS standard photos in determining H/Ma (hemorrhage/microaneurysm) severity, with excellent correlation of H/Ma counts within ETDRS photo fields. Utilizing the full capability of UWF peripheral fields however, produced identification of 49.8% more H/Ma suggesting a more severe H/Ma in 12.7% of eyes.

Dr. Paolo Silva, Beetham Eye Institute, Boston MA

Retinal hemorrhage and/or H/Ma are critical clinical signs of early DR; similarly, the presence and severity of H/Ma are considered reliable markers for the level and risk of progression in DR. Ma (microaneurysm) counts and level also may indicate critical progression of proliferative DR and macular edema.

The objective of the study was to evaluate detection of H/Ma and/or hemorrhage comparing the two aforementioned modalities. When first evaluating a similar retinal scope of the two modalities, both UWF imaging and ETDRS revealed similar numbers of H/Mas.

The subsequent study protocol, utilizing the full scope of UWF retinal imaging, provided 4x more visualized area in comparison to the ETDRS 7 standard fields. This expanded view revealed up to 50% more H/Ma in the 126 eyes of the 69 evaluated patients.

The peripheral lesions that were identified on UWF images were primarily H/Mas which have been clinically noted to indicate an increased risk for DR progression and are also associated with retinal nonperfusion.

Results of the study offer a tremendous indication that the 200° visualization of 50% more H/Ma potentially provides a more accurate assessment of disease activity, than does the ETDRS current gold standard.

“The use of a retina wide quantification of H/Mas using UWF images may provide a more accurate assessment of the overall DR severity, and a more accurate prediction of DR progression and/or DME development. If these findings persist across a broad diabetic population, these noninvasive measures of posterior and peripheral retina may further improve our ability to identify eyes at risk for retinopathy progression, aiding in monitoring and administration of timely treatment.” – Paolo S. Silva, MD

In summary, of the 126 eyes of 69 evaluated patients the following comparisons between ETDRS and optomap UWF imaging were observed and documented:

– A total of 748 of 756 fields were gradable for H/Mas on ETDRS and UWF images with overall exact agreement in 81.3% and within one step in 97.9% of fields.

–  A greater proportion of fields was graded a more severe H/Ma level in UWF images than in ETDRS photos. Simply comparing comparable fields between the two modalities resulted in 42.8% H/Mas in ETDRS and 48.8% in UWF.  However, an additional 21.3% H/Mas were identified in the peripheral fields of the UWF images.

– 49.8% more H/Mas were identified in the optomap UWF images than with ETDRS photos

Sources:

1. Nonmydriatic Ultra-wide Field Retinal Imaging Compared with Dilated Standard 7-Field 35-mm Photography and Retinal Specialist Examination for Evaluation of Diabetic Retinopathy, Silva, Cavellerano, Sun, Noble, Aiello, American Journal of Ophthalmology. 2012.
2. Peripheral Lesions Identified by Mydriatic Ultrawide Field Imaging: Distribution and Potential Impact on Diabetic Retinopathy Severity. Ophthalmology. 2013
3. Hemorrhage and/or Microaneurysm Severity and Count in Ultrawide Field Images and Early Treatment Diabetic Retinopathy Study Photography. Silva PS¹, El-Rami H², Barham R², Gupta A², Fleming A³, van Hemert J³, Cavallerano JD⁴, Sun JK⁴, Aiello LP⁴.Ophthalmology. 2017 Jul;124(7):970-976.