@article {1490435, title = {Disparity of microaneurysm count between ultrawide field colour imaging and ultrawide field fluorescein angiography in eyes with diabetic retinopathy}, journal = {Br J Ophthalmol}, volume = {104}, number = {12}, year = {2020}, month = {2020 Dec}, pages = {1762-1767}, abstract = {AIMS: To compare microaneurysm (MA) counts using ultrawide field colour images (UWF-CI) and ultrawide field fluorescein angiography (UWF-FA). METHODS: Retrospective study including patients with type 1 or 2 diabetes mellitus receiving UWF-FA and UWF-CI within 2 weeks. MAs were manually counted in individual Early Treatment Diabetic Retinopathy Study (ETDRS) and extended UWF zones. Fields with MAs >=20 determined diabetic retinopathy (DR) severity (0 fields=mild, 1-3=moderate, >=4=severe). UWF-FA and UWF-CI agreement was determined and UWF-CI DR severity sensitivity analysis adjusting for UWF-FA MA counts performed. RESULTS: In 193 patients (288 eyes), 2.4\% had no DR, 29.9\% mild non-proliferative DR (NPDR), 32.6\% moderate (NPDR), 22.9\% severe NPDR and 12.2\% proliferative DR. UWF-FA MA counts were 3.5-fold higher (p\<0.001) than UWF-CI counts overall, 3.2x-fold higher in ETDRS fields (p\<0.001) and 5.3-fold higher in extended ETDRS fields (p\<0.001) and higher in type 1 versus type 2 diabetes (p\<0.001). In eyes with NPDR on UWF-CI (n=246), UWF-FA images had 1.6x-3.5x more fields with >=20 MAs (p\<0.001). Fair agreement existed between imaging modalities (k=0.221-0.416). In ETDRS fields, DR severity agreement increased from k=0.346 to 0.600 when dividing UWF-FA counts by a factor of 3, followed by rapid decline in agreement thereafter. Total UWF area agreement increased from k=0.317 to 0.565 with an adjustment factor of either 4 or 5. CONCLUSIONS: UWF-FA detects threefold to fivefold more MAs than UWF-CI and identifies 1.6-3.5-fold more fields affecting DR severity. Differences exist at all DR severity levels, thus limiting direct comparison between the modalities. However, correcting UWF-FA MA counts substantially improves DR severity agreement between the modalities.}, issn = {1468-2079}, doi = {10.1136/bjophthalmol-2019-315807}, author = {Ashraf, Mohamed and Sampani, Konstantina and AbdelAl, Omar and Fleming, Alan and Cavallerano, Jerry and Souka, Ahmed and El Baha, Samir Mohamed and Silva, Paolo S and Sun, Jennifer and Aiello, Lloyd Paul} }