Aditya Verma1,2,3, Ahmed Roshdy Alagorie1,2,4, Kim Ramasamy5, Jano van Hemert6, N K Yadav7, Rajeev R Pappuru8, Adnan Tufail9, Muneesawar Gupta Nittala1, SriniVas R Sadda1,2, Rajiv Raman10,11. 1. Doheny Image Reading Center, Doheny Eye Institute, 1350 San Pablo St., Los Angeles, CA, 90033, USA. 2. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 3. Sankara Nethralaya, 18, College road, Chennai, India. 4. Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt. 5. Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India. 6. Optos Plc, Dunfermline, Dunfermline, UK. 7. Narayana Nethralaya, Chord Road, 1st 'R' Block, Rajajinagar, Bangalore, 560010, India. 8. Smt. Kanuri Santhamma Vitreoretina Center, LV Prasad Eye Institute, Hyderabad, India. 9. Moorfields Eye Hospital, London, UK. 10. Sankara Nethralaya, 18, College road, Chennai, India. rajivpgraman@gmail.com. 11. Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, College Road 18, Nungambakkam, Chennai, 600006, India. rajivpgraman@gmail.com.
Abstract
PURPOSE: To analyze the distribution of diabetic retinopathy (DR) lesions in an Indian population using ultra-wide field (UWF) fundus imaging. METHODS: Seven hundred fifteen subjects (1406 eyes) with diabetic retinopathy in India were enrolled in this multicenter, prospective, observational study using UWF pseudocolor imaging with Optos Daytona Plus (Optos plc, Dunfermline, Scotland, UK). Images were transmitted to Doheny Image Reading Center, Los Angeles, CA, for grading. The ETDRS grid was overlaid on stereographic projections of UWF images, and images were graded independently by 2 masked graders. Lesion distribution was graded as predominantly central (PCL) or predominantly peripheral (PPL) according to previous criteria, considering both lesion number and area. An image was graded as PPL if > 50% of the lesion area was seen in at least one peripheral field as compared with the corresponding ETDRS field. Diabetic retinopathy severity was also assessed based on the International Classification of Diabetic Retinopathy (ICDR) grading scale. The main outcome measures were lesion distribution (PPL versus PCL): overall and within specific fields in eyes with various grades of DR. RESULTS: Lesion distribution was rated to be PPL in 37% of eyes and PCL in 63% of eyes (P < 0.003). The frequency of a PPL distribution varied significantly across all ICDR severity levels, with frequencies of mild non-proliferative DR (NPDR) (30.9%), moderate NPDR (40.3%), severe NPDR (38.5%) and PDR (34.9%), P = 0.005. When assessing which individual fields were rated to show a PPL distribution, the frequency was greatest in field 4 and least in field 7. For any grade of DR, temporal fields showed the greatest PPL frequency, followed in order by the superior, inferior, and nasal fields (P < 0.001). Only 3.5% of eyes showed PPL distribution in all five peripheral fields. CONCLUSIONS: One-third of the UWF images showed a PPL distribution in this cohort with the temporal quadrant having the widest distribution of PPL. As the PPL distribution varied significantly between various grades of DR, UWF imaging may prove to be important for screening of referral warranted retinopathy.
PURPOSE: To analyze the distribution of diabetic retinopathy (DR) lesions in an Indian population using ultra-wide field (UWF) fundus imaging. METHODS: Seven hundred fifteen subjects (1406 eyes) with diabetic retinopathy in India were enrolled in this multicenter, prospective, observational study using UWF pseudocolor imaging with Optos Daytona Plus (Optos plc, Dunfermline, Scotland, UK). Images were transmitted to Doheny Image Reading Center, Los Angeles, CA, for grading. The ETDRS grid was overlaid on stereographic projections of UWF images, and images were graded independently by 2 masked graders. Lesion distribution was graded as predominantly central (PCL) or predominantly peripheral (PPL) according to previous criteria, considering both lesion number and area. An image was graded as PPL if > 50% of the lesion area was seen in at least one peripheral field as compared with the corresponding ETDRS field. Diabetic retinopathy severity was also assessed based on the International Classification of Diabetic Retinopathy (ICDR) grading scale. The main outcome measures were lesion distribution (PPL versus PCL): overall and within specific fields in eyes with various grades of DR. RESULTS: Lesion distribution was rated to be PPL in 37% of eyes and PCL in 63% of eyes (P < 0.003). The frequency of a PPL distribution varied significantly across all ICDR severity levels, with frequencies of mild non-proliferative DR (NPDR) (30.9%), moderate NPDR (40.3%), severe NPDR (38.5%) and PDR (34.9%), P = 0.005. When assessing which individual fields were rated to show a PPL distribution, the frequency was greatest in field 4 and least in field 7. For any grade of DR, temporal fields showed the greatest PPL frequency, followed in order by the superior, inferior, and nasal fields (P < 0.001). Only 3.5% of eyes showed PPL distribution in all five peripheral fields. CONCLUSIONS: One-third of the UWF images showed a PPL distribution in this cohort with the temporal quadrant having the widest distribution of PPL. As the PPL distribution varied significantly between various grades of DR, UWF imaging may prove to be important for screening of referral warranted retinopathy.
Entities:
Keywords:
Diabetic retinopathy; Predominantly peripheral lesions; Ultra-wide field imaging
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