Assessment of diabetic retinopathy using two ultra-wide-field fundus imaging systems, the Clarus® and Optos™ systems

Takao Hirano, Akira Imai, Hirotsugu Kasamatsu, Shinji Kakihara, Yuichi Toriyama, Toshinori Murata, Takao Hirano, Akira Imai, Hirotsugu Kasamatsu, Shinji Kakihara, Yuichi Toriyama, Toshinori Murata

Abstract

Background: The ability to image wide fundus fields and to conduct swift, non-invasive examinations is increasingly important with the escalation in patients with diabetic retinopathy (DR).

Methods: Fifty eyes of 28 consecutive patients with DR were examined in this prospective observational study. A total of 46 eyes, 25 right and 21 left eyes, of 27 patients (male, 19; female, 8) were ultimately included in the analysis. All patients underwent comprehensive ophthalmological examination. A single image each was obtained using two ultra-wide-field (UWF) imaging systems: Optos® (Optos Carfornia®, Optos PLC, Dunfermline, United Kingdom) and Clarus™ (CLARUS 500™, Carl Zeiss Meditec Inc., Californea, USA), without mydriasis. The total retinal area captured and the obscured retinal area were compared between the two systems using nonparametric Wilcoxon matched-pairs signed-rank analysis. Early Treatment of Diabetic Retinopathy Study (ETDRS) and International Clinical DR severity were analyzed by κ statistics.

Results: The Optos® allowed capture of larger areas of the fundus than the Clarus™ (465 ± 117 vs. 243 ± 39 disc areas, P < 0.0001). In 85% (39/46) of Optos® images and 7% (3/46) of Clarus™ images, a slightly obscured area was observed within the ETDRS-7 field area. κ values for ETDRS DR severity and International Clinical DR severity between the Optos® and Clarus™ images were 0.88 and 0.79, respectively. Severity was higher according to Clarus™ images in two eyes in which the ETDRS DR severity grading differed between the systems. Severity was higher in four Clarus™ images and in a single Optos® image in five eyes in which the International Clinical DR severity grading differed between the systems.

Conclusion: The Optos® and Clarus™ UWF retinal imaging systems were useful for examining eyes with DR, using single images obtained without mydriasis. The systems were both generally consistent in assessing DR severity, with some partial discrepancies. It is important to understand the characteristics of each respective UWF retinal imaging system when using them to assess DR.

Keywords: Diabetic mellitus; Diabetic retinopathy; Early treatment of diabetic retinopathy study diabetic retinopathy severity; International clinical diabetic retinopathy severity; Ultra-wide-field retinal imaging systems.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institutional review board (UMIN 000029098). Written informed consent was obtained from all patients.

Consent for publication

Inform consent were acquired from each enrolled patient.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

Figures

Fig. 1
Fig. 1
Comparison of captured total retinal area. a Retinal image captured by Optos®. b Retinal image captured by Clarus™. The blue line excluding the yellow dotted line, which indicates an obscured area, shows the area of visible retina and the red line shows the optic nerve head in (a) and (b). c Captured total retinal area shows significantly higher values in Optos® images than in Clarus™ images (465 ± 117 vs. 243 ± 39 DA, ***P < 0.001). DA: disc area
Fig. 2
Fig. 2
Comparison of obscured retinal area in ETDRS 7-field area. a ETDRS 7-field cropped from an Optos® image. b ETDRS 7-field cropped from a Clarus™ image. The blue line circles in (a) and (b) show the ETDRS 7-field. The number in (a) and (b) indicate the number of the ETDRS 7-field. The yellow dotted lines in (a) show the obscured area. c Obscured total retinal area was significantly greater in Optos® images than in Clarus™ images (4.15 ± 4.00% vs. 0.47 ± 1.87%, ***P < 0.001). ETDRS: Early Treatment of Diabetic Retinopathy Study

References

    1. Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med. 2012;366(13):1227–1239. doi: 10.1056/NEJMra1005073.
    1. Early treatment diabetic retinopathy study research group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991;98(5 Suppl):786–806.
    1. Wilkinson CP, Ferris FL, 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677–1682. doi: 10.1016/S0161-6420(03)00475-5.
    1. Hirano T, Iesato Y, Toriyama Y, Imai A, Chiba D, Murata T. Correlation between diabetic retinopathy severity and elevated skin autofluorescence as a marker of advanced glycation end-product accumulation in type 2 diabetic patients. J Diabetes Complicat. 2014;28(5):729–734. doi: 10.1016/j.jdiacomp.2014.03.003.
    1. Abramoff MD, Folk JC, Han DP, Walker JD, Williams DF, Russell SR, Massin P, Cochener B, Gain P, Tang L, et al. Automated analysis of retinal images for detection of referable diabetic retinopathy. JAMA Ophthalmol. 2013;131(3):351–357. doi: 10.1001/jamaophthalmol.2013.1743.
    1. Hazin R, Colyer M, Lum F, Barazi MK. Revisiting diabetes 2000: challenges in establishing nationwide diabetic retinopathy prevention programs. Am J Ophthalmol. 2011;152(5):723–729. doi: 10.1016/j.ajo.2011.06.022.
    1. Ghasemi Falavarjani K, Tsui I, Sadda SR. Ultra-wide-field imaging in diabetic retinopathy. Vis Res. 2017;139:187–190. doi: 10.1016/j.visres.2017.02.009.
    1. Silva PS, Cavallerano JD, Sun JK, Noble J, Aiello LM, Aiello LP. Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy. Am J Ophthalmol. 2012;154(3):549–559. doi: 10.1016/j.ajo.2012.03.019.
    1. Rasmussen ML, Broe R, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Comparison between early treatment diabetic retinopathy study 7-field retinal photos and non-mydriatic, mydriatic and mydriatic steered widefield scanning laser ophthalmoscopy for assessment of diabetic retinopathy. J Diabetes Complicat. 2015;29(1):99–104. doi: 10.1016/j.jdiacomp.2014.08.009.
    1. Kernt M, Hadi I, Pinter F, Seidensticker F, Hirneiss C, Haritoglou C, Kampik A, Ulbig MW, Neubauer AS. Assessment of diabetic retinopathy using nonmydriatic ultra-widefield scanning laser ophthalmoscopy (Optomap) compared with ETDRS 7-field stereo photography. Diabetes Care. 2012;35(12):2459–2463. doi: 10.2337/dc12-0346.
    1. Mackenzie PJ, Russell M, Ma PE, Isbister CM, Maberley DA. Sensitivity and specificity of the optos optomap for detecting peripheral retinal lesions. Retina. 2007;27(8):1119–1124. doi: 10.1097/IAE.0b013e3180592b5c.
    1. Early treatment diabetic retinopathy study research group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98(5 Suppl):823–33.
    1. Altman DG. Statistics in medical journals: developments in the 1980s. Stat Med. 1991;10(12):1897–1913. doi: 10.1002/sim.4780101206.
    1. Ghasemi Falavarjani K, Wang K, Khadamy J, Sadda SR. Ultra-wide-field imaging in diabetic retinopathy; an overview. J Curr Ophthalmol. 2016;28(2):57–60. doi: 10.1016/j.joco.2016.04.001.
    1. Price LD, Au S, Chong NV. Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with diabetic retinopathy. Clin Ophthalmol. 2015;9:527–531. doi: 10.2147/OPTH.S79448.
    1. Silva PS, Dela Cruz AJ, Ledesma MG, van Hemert J, Radwan A, Cavallerano JD, Aiello LM, Sun JK, Aiello LP. Diabetic retinopathy severity and peripheral lesions are associated with nonperfusion on Ultrawide field angiography. Ophthalmology. 2015;122(12):2465–2472. doi: 10.1016/j.ophtha.2015.07.034.
    1. Kernt M, Pinter F, Hadi I, Hirneiss C, Haritoglou C, Kampik A, Ulbig MW, Neubauer AS. Diabetic retinopathy: comparison of the diagnostic features of ultra-widefield scanning laser ophthalmoscopy Optomap with ETDRS 7-field fundus photography. Ophthalmologe. 2011;108(2):117–123. doi: 10.1007/s00347-010-2226-4.
    1. Neubauer AS, Kernt M, Haritoglou C, Priglinger SG, Kampik A, Ulbig MW. Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy (Optomap) Graefes Arch Clin Exp Ophthalmol. 2008;246(2):229–235. doi: 10.1007/s00417-007-0631-4.

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