Reliability of clinical grading of diabetic retinopathy compared with grading of ultra-widefield images

Daniela Castellanos-Canales; Nicole L. Decker; Hisashi Fukuyama; Brandon V. Duffy; Amani A. Fawzi

doi:10.1097/IAE.0000000000004140

Reliability of clinical grading of diabetic retinopathy compared with grading of ultra-widefield images

Daniela Castellanos-Canales, Nicole L. Decker, Hisashi Fukuyama, Brandon V. Duffy, Amani A. Fawzi^*

^*Corresponding author for this work

Ophthalmology

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose:To evaluate the reliability of clinical grading of diabetic retinopathy (DR) severity compared with grading on ultra-widefield pseudocolor fundus (UWF-CF) and ultra-widefield fluorescein angiography (UWF-FA) images and their relative detection of sight-threatening DR and referable DR.Methods:A total of 184 diabetic eyes were analyzed. UWF-CF and UWF-FA images were graded based on the International Clinical Diabetic Retinopathy severity scale. Agreement between clinical and UWF-based severity grading was evaluated using Cohen's kappa coefficient. The rate of sight-threatening DR and referable DR was evaluated for each grading method.Results:Moderate agreement was found between clinical grading and UWF-CF (k = 0.456, P < 0.001) and between UWF-CF and UWF-FA (k = 0.443, P < 0.001). The agreement between clinical grading and UWF-FA was fair (k = 0.397, P < 0.001). UWF-based grading identified a higher DR grade in 56 eyes (30%) on UWF-CF and 85 eyes (46.2%) on UWF-FA. Compared with clinical grading, UWF-FA detected a higher rate of sight-threatening DR (44%; 81/184 vs. 22.3%; 41/184), while UWF-CF detected more referable eyes (58.1%; 107/184 vs. 45.65%; 84/184).Conclusion:Ultra-widefield pseudocolor fundus is a valuable tool for identifying referable eyes and can be a useful, noninvasive adjunct to clinical grading. The results suggest that UWF-FA is particularly useful for detecting unsuspected sight-threatening DR in eyes with clinically referable DR.

Original language	English (US)
Pages (from-to)	1279-1287
Number of pages	9
Journal	Retina
Volume	44
Issue number	8
DOIs	https://doi.org/10.1097/IAE.0000000000004140
State	Published - Aug 1 2024

Funding

Supported by NIH Grant R01EY31815 (A. A. Fawzi), Ruth L. Kirschstein, National Research Service Award, Grant/Award Number: 5T32DK007169 (D. Castellanos-Canales), and a collaborative grant agreement from Boehringer Ingelheim Supported by NIH Grant R01EY31815 (A. A. Fawzi), Ruth L. Kirschstein, National Research Service Award, Grant/Award Number: 5T32DK007169 (D. Castellanos-Canales), and a collaborative grant agreement from Boehringer Ingelheim.

Keywords

diabetic retinopathy
fluorescein angiography
imaging
retina
ultra-widefield

ASJC Scopus subject areas

Ophthalmology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/IAE.0000000000004140

Cite this

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title = "Reliability of clinical grading of diabetic retinopathy compared with grading of ultra-widefield images",

abstract = "Purpose:To evaluate the reliability of clinical grading of diabetic retinopathy (DR) severity compared with grading on ultra-widefield pseudocolor fundus (UWF-CF) and ultra-widefield fluorescein angiography (UWF-FA) images and their relative detection of sight-threatening DR and referable DR.Methods:A total of 184 diabetic eyes were analyzed. UWF-CF and UWF-FA images were graded based on the International Clinical Diabetic Retinopathy severity scale. Agreement between clinical and UWF-based severity grading was evaluated using Cohen's kappa coefficient. The rate of sight-threatening DR and referable DR was evaluated for each grading method.Results:Moderate agreement was found between clinical grading and UWF-CF (k = 0.456, P < 0.001) and between UWF-CF and UWF-FA (k = 0.443, P < 0.001). The agreement between clinical grading and UWF-FA was fair (k = 0.397, P < 0.001). UWF-based grading identified a higher DR grade in 56 eyes (30%) on UWF-CF and 85 eyes (46.2%) on UWF-FA. Compared with clinical grading, UWF-FA detected a higher rate of sight-threatening DR (44%; 81/184 vs. 22.3%; 41/184), while UWF-CF detected more referable eyes (58.1%; 107/184 vs. 45.65%; 84/184).Conclusion:Ultra-widefield pseudocolor fundus is a valuable tool for identifying referable eyes and can be a useful, noninvasive adjunct to clinical grading. The results suggest that UWF-FA is particularly useful for detecting unsuspected sight-threatening DR in eyes with clinically referable DR.",

keywords = "diabetic retinopathy, fluorescein angiography, imaging, retina, ultra-widefield",

author = "Daniela Castellanos-Canales and Decker, {Nicole L.} and Hisashi Fukuyama and Duffy, {Brandon V.} and Fawzi, {Amani A.}",

note = "Publisher Copyright: Copyright {\textcopyright} by Ophthalmic Communications Society, Inc.",

year = "2024",

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language = "English (US)",

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T1 - Reliability of clinical grading of diabetic retinopathy compared with grading of ultra-widefield images

AU - Castellanos-Canales, Daniela

AU - Decker, Nicole L.

AU - Fukuyama, Hisashi

AU - Duffy, Brandon V.

AU - Fawzi, Amani A.

PY - 2024/8/1

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N2 - Purpose:To evaluate the reliability of clinical grading of diabetic retinopathy (DR) severity compared with grading on ultra-widefield pseudocolor fundus (UWF-CF) and ultra-widefield fluorescein angiography (UWF-FA) images and their relative detection of sight-threatening DR and referable DR.Methods:A total of 184 diabetic eyes were analyzed. UWF-CF and UWF-FA images were graded based on the International Clinical Diabetic Retinopathy severity scale. Agreement between clinical and UWF-based severity grading was evaluated using Cohen's kappa coefficient. The rate of sight-threatening DR and referable DR was evaluated for each grading method.Results:Moderate agreement was found between clinical grading and UWF-CF (k = 0.456, P < 0.001) and between UWF-CF and UWF-FA (k = 0.443, P < 0.001). The agreement between clinical grading and UWF-FA was fair (k = 0.397, P < 0.001). UWF-based grading identified a higher DR grade in 56 eyes (30%) on UWF-CF and 85 eyes (46.2%) on UWF-FA. Compared with clinical grading, UWF-FA detected a higher rate of sight-threatening DR (44%; 81/184 vs. 22.3%; 41/184), while UWF-CF detected more referable eyes (58.1%; 107/184 vs. 45.65%; 84/184).Conclusion:Ultra-widefield pseudocolor fundus is a valuable tool for identifying referable eyes and can be a useful, noninvasive adjunct to clinical grading. The results suggest that UWF-FA is particularly useful for detecting unsuspected sight-threatening DR in eyes with clinically referable DR.

AB - Purpose:To evaluate the reliability of clinical grading of diabetic retinopathy (DR) severity compared with grading on ultra-widefield pseudocolor fundus (UWF-CF) and ultra-widefield fluorescein angiography (UWF-FA) images and their relative detection of sight-threatening DR and referable DR.Methods:A total of 184 diabetic eyes were analyzed. UWF-CF and UWF-FA images were graded based on the International Clinical Diabetic Retinopathy severity scale. Agreement between clinical and UWF-based severity grading was evaluated using Cohen's kappa coefficient. The rate of sight-threatening DR and referable DR was evaluated for each grading method.Results:Moderate agreement was found between clinical grading and UWF-CF (k = 0.456, P < 0.001) and between UWF-CF and UWF-FA (k = 0.443, P < 0.001). The agreement between clinical grading and UWF-FA was fair (k = 0.397, P < 0.001). UWF-based grading identified a higher DR grade in 56 eyes (30%) on UWF-CF and 85 eyes (46.2%) on UWF-FA. Compared with clinical grading, UWF-FA detected a higher rate of sight-threatening DR (44%; 81/184 vs. 22.3%; 41/184), while UWF-CF detected more referable eyes (58.1%; 107/184 vs. 45.65%; 84/184).Conclusion:Ultra-widefield pseudocolor fundus is a valuable tool for identifying referable eyes and can be a useful, noninvasive adjunct to clinical grading. The results suggest that UWF-FA is particularly useful for detecting unsuspected sight-threatening DR in eyes with clinically referable DR.

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KW - fluorescein angiography

KW - imaging

KW - retina

KW - ultra-widefield

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Reliability of clinical grading of diabetic retinopathy compared with grading of ultra-widefield images

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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