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Distribution of peripheral lesions identified by mydriatic ultra-wide field fundus imaging in diabetic retinopathy

  • Retinal Disorders
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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.

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Acknowledgments

The following are members of IRRA Study group: Kim Ramasamy, Jano van Hemert, Yadav NK, Rajeev R Pappuru, Adnan Tufail, Muneesawar Gupta, SriniVas R. Sadda, and Rajiv Raman.

Financial information

AV: none; ARA: none; KR: None; JvH: Optos (E); YNK: none; RRP: none; AT: Allergan, Heidelberg Engineering, Bayer, Novartis, Oxurion, Roche.; MNG: none; SRS: Allergan (C, F), Carl Zeiss Meditec (C,F), Centervue (C), Genentech (C, F), Heidelberg Engineering (C), Iconic (C), NightstarX (C), Novartis (C), Optos (C,F), Oxurion(C), Topcon (C); RR: none.

Author information

Authors and Affiliations

  1. Doheny Image Reading Center, Doheny Eye Institute, 1350 San Pablo St., Los Angeles, CA, 90033, USA

    Aditya Verma, Ahmed Roshdy Alagorie, Muneesawar Gupta Nittala & SriniVas R. Sadda

  2. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Aditya Verma, Ahmed Roshdy Alagorie & SriniVas R. Sadda

  3. Sankara Nethralaya, 18, College road, Chennai, India

    Aditya Verma & Rajiv Raman

  4. Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed Roshdy Alagorie

  5. Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India

    Kim Ramasamy

  6. Optos Plc, Dunfermline, Dunfermline, UK

    Jano van Hemert

  7. Narayana Nethralaya, Chord Road, 1st ‘R’ Block, Rajajinagar, Bangalore, 560010, India

    NK Yadav

  8. Smt. Kanuri Santhamma Vitreoretina Center, LV Prasad Eye Institute, Hyderabad, India

    Rajeev R Pappuru

  9. Moorfields Eye Hospital, London, UK

    Adnan Tufail

  10. Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, College Road 18, Nungambakkam, Chennai, 600006, India

    Rajiv Raman

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  1. Aditya Verma
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Indian Retina Research Associates (IRRA)

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Correspondence to Rajiv Raman.

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Aditya Verma and Ahmed Roshdy Alagorie are co-first authors.

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Verma, A., Alagorie, A.R., Ramasamy, K. et al. Distribution of peripheral lesions identified by mydriatic ultra-wide field fundus imaging in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 258, 725–733 (2020). https://doi.org/10.1007/s00417-020-04607-w

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  • DOI: https://doi.org/10.1007/s00417-020-04607-w

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