Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Combined wide-field imaging in grading diabetic retinopathy

Eye volume 38, pages 210–214 (2024)Cite this article

Subjects

Abstract

Objectives

To detect retinal neovascularization elsewhere (NVE), of the optic disc (NVD) and intraretinal microvascular abnormalities (IRMA) in treatment naive diabetic retinopathy (DR) and compare these findings by using 90° Wide-Field Colour Fundus Photography (WF CFP), Wide-Field Spectral-Domain Optical Coherence Tomography Angiography (OCTA) and the combination of WF CFP and OCTA through overlay software.

Methods

Patients with treatment naive severe non-proliferative DR or proliferative DR were prospectively enrolled. All patients underwent WF-CFP and OCTA in the same day. Two readers independently analysed WF-CFP, SD-OCTA and the overlay of the two techniques. The degree of agreement between the two raters and between different techniques (WF CFP, OCTA, WF CFP combined to OCTA) were measured with Cohen’s Kappa coefficient.

Results

Thirty-one eyes from 21 patients (10 males, mean age 63 ± 15 years) were included. Inter-rater agreement by using WF-CFP in detection of NVE, NVD and IRMA was respectively 0.62, 0.22 and 0.55. OCTA scored values of inter-rater agreement of 0.86, 0.87 and 0.92 in detection of NVE, NVD and IRMA, respectively. By combining WF-CFP and SD-OCTA, inter-rater agreement in detection of NVE, NVD and IRMA was 0.93, 0.94 and 0.89, respectively.

Conclusion

Inter-rater agreement in detection of NVE, NVD and IRMA was substantial, fair and moderate, respectively. OCTA provided almost perfect values of inter-rater agreement in NVE, NVD and IRMA detection. Combining WF-CFP and OCTA further empowered concordance values in detection of NVE and NVD. Combining OCTA and WF-CFP is the best performance to detect NVE and NVD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Detection of neovascularization elsewhere (NVE) (yellow circled areas) with three different techniques.
Fig. 2: Detection of neovascularization of the optic disc (NVD) (yellow circled areas) with three different techniques.
Fig. 3: Detection of intraretinal microvascular abnormalities (IRMA) (yellow circled areas) with three different techniques.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at IRCCS Ospedale San Raffaele.

References

  1. Early photocoagulation for diabetic retinopathy: ETDRS Report Number 9. Ophthalmology. 1991;98:786–806.

  2. Sacconi R, Casaluci M, Borrelli E, Mulinacci G, Lamanna F, Gelormini F, et al. Multimodal imaging assessment of vascular and neurodegenerative retinal alterations in type 1 diabetic patients without fundoscopic signs of diabetic retinopathy. J Clin Med. 2019;8:1409.

  3. Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110:1677–82.

  4. Solomon SD, Goldberg MF. ETDRS grading of diabetic retinopathy: still the gold standard? Ophthalmic Research. 2019;62:190–5.

  5. Classification of diabetic retinopathy from fluorescein angiograms: ETDRS Report Number 11. Ophthalmology. 1991;98:807–22.

  6. Soares M, Neves C, Marques IP, Pires I, Schwartz C, Costa MÂ, et al. Comparison of diabetic retinopathy classification using fluorescein angiography and optical coherence tomography angiography. Br J Ophthalmol. 2017;101:62–8.

  7. Grading diabetic retinopathy from stereoscopic color fundus photographs — an extension of the modified airlie house classification: ETDRS Report Number 10. Ophthalmology. 2020;127:786–806.

  8. Early Treatment Diabetic Retinopathy Study Design and Baseline Patient Characteristics: ETDRS Report Number 7. Ophthalmology. 1991;98:741–56.

  9. Lee CS, Lee AY, Sim DA, Keane PA, Mehta H, Zarranz-Ventura J, et al. Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography. Am J Ophthalmol. 2015;159:101–10.e1.

  10. Schaal KB, Munk MR, Wyssmueller I, Berger LE, Zinkernagel MS, Wolf S. Vascular abnormalities in diabetic retinopathy assessed with swept-source optical coherence tomography angiography widefield imaging. Retina. 2019;39:79–87.

  11. McHugh ML. Interrater reliability: The kappa statistic. Biochem Med. 2012;22:276–82.

  12. Arya M, Sorour O, Chaudhri J, Alibhai Y, Waheed NK, Duker JS, et al. Distinguishing intraretinal microvascular abnormalities from retinal neovascularization using optical coherence tomography angiography. Retina. 2020;40:1686–95.

  13. Cui Y, Zhu Y, Wang JC, Lu Y, Zeng R, Katz R, et al. Comparison of widefield swept-source optical coherence tomography angiography with ultra-widefield colour fundus photography and fluorescein angiography for detection of lesions in diabetic retinopathy. Br J Ophthalmol. 2021;105:577–81.

  14. Wang M, Garg I, Miller JB. Wide field swept source optical coherence tomography angiography for the evaluation of proliferative diabetic retinopathy and associated lesions: a review. Semin Ophthalmol. 2021;36:162–7.

  15. Li M, Mao M, Wei D, Liu M, Liu X, Leng H, et al. Different scan areas affect the detection rates of diabetic retinopathy lesions by high-speed ultra-widefield swept-source optical coherence tomography angiography. Front Endocrinol. 2023;14:1111360.

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy

    Matteo Menean, Riccardo Sacconi, Beatrice Tombolini, Federico Fantaguzzi, Francesco Bandello & Giuseppe Querques

  2. Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Matteo Menean, Riccardo Sacconi, Beatrice Tombolini, Federico Fantaguzzi, Francesco Bandello & Giuseppe Querques

Authors
  1. Matteo Menean
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Sacconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beatrice Tombolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federico Fantaguzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Bandello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giuseppe Querques
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the conception or design of the work, the acquisition, analysis, and interpretation of data, drafting the work, and revising it critically for important intellectual content. Each coauthor has seen and agrees with how his name is listed.

Corresponding author

Correspondence to Giuseppe Querques.

Ethics declarations

Competing interests

MM, BT, FF have nothing to disclose. RS has the following disclosures: Allergan Inc, Bayer Shering-Pharma, Medivis, Novartis, Zeiss. FB has the following disclosures: Allergan Inc, Bayer Shering-Pharma, Boehringer-Ingelheim, Fidia Sooft, Hofmann La Roche, Novartis, NTC Pharma, Oxurion NV, Sifi. GQ has the following disclosures: Alimera Sciences, Allergan Inc, Amgen, Bayer Shering-Pharma, Heidelberg, KBH, LEH Pharma, Lumithera, Novartis, Sandoz, Sifi, Sooft-Fidea, Zeiss. The authors have no competing interest in publishing the present work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Menean, M., Sacconi, R., Tombolini, B. et al. Combined wide-field imaging in grading diabetic retinopathy. Eye 38, 210–214 (2024). https://doi.org/10.1038/s41433-023-02666-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-023-02666-x

This article is cited by

Search

Advanced search

Quick links