@article {1664972,
	title = {Evaluation of diabetic retinopathy severity on ultrawide field colour images compared with ultrawide fluorescein angiograms},
	journal = {Br J Ophthalmol},
	volume = {107},
	number = {4},
	year = {2023},
	month = {2023 Apr},
	pages = {534-539},
	abstract = {PURPOSE: To compare Early Treatment Diabetic Retinopathy Study (ETDRS) diabetic retinopathy (DR) severity on ultrawide field (UWF) colour imaging (CI) and UWF fluorescein angiography (FA). DESIGN: Cross-sectional retrospective review. SUBJECTS: Patients with diabetes mellitus and at least mild non-proliferative DR on UWF-CI. METHODS: UWF-CI and UWF-FA images acquired within 1 month of each other were evaluated independently using ETDRS DR Severity Scale (DRSS) for colour photography adapted for UWF-CI and UWF-FA. Extent of non-perfusion (NP, mm2) was determined from UWF-FA images. MAIN OUTCOME MEASURES: Agreement rate between DRSS on UWF-CI and UWF-FA. RESULTS: Images from 218 eyes of 137 patients with diabetes were evaluated. Agreement rate for DRSS between UWF-CI and UWF-FA was moderate to substantial (K=0.46, Kw=0.65). Over-all, DRSS was worse in 73 (33.5\%) eyes on UWF-FA and in 16 (7.3\%) on UWF-CI. Compared to UWF-CI, UWF-FA identified more severe DRSS in 26.5\% (1 step) and 7.34\% (>=2 steps) of eyes. DRSS was worse than UWF-FA in 56 (51.4\%) in early DR (ETDRS levels 20-47, N=109) and 17 (15.6\%) in eyes with severe DR (53 and higher, N=109). In this cohort, the extent of NP significantly increased as eyes approach moderate non-proliferative DR (levels 43-47, p=0.0065). CONCLUSION: When evaluating UWF-FA images using the ETDRS colour severity scale, DRSS is graded as more severe in a substantial number of eyes than when evaluating UWF-CI. It is uncertain how the DRSS levels using UWF-FA translate to clinical outcomes, but the additional lesions detected might provide added prognostic value. These and other recent data emphasise the need of obtaining outcome data based on UWF-FA and the potential need to develop DRSS specifically tailored for UWF-FA images.},
	keywords = {Color, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Retinopathy, Fluorescein Angiography, Fluoresceins, Humans, Photography},
	issn = {1468-2079},
	doi = {10.1136/bjo-2022-322163},
	author = {Ashraf, Mohamed and AbdelAl, Omar and Shokrollahi, Siamak and Pitoc, Cloyd M and Aiello, Lloyd Paul and Silva, Paolo S}
}
