UWF-FA identifies retinopathy earlier than UWF photography alone
In eyes with less severe diabetic retinopathy, ultra-widefield fluorescein angiography identifies the more severe form earlier and allows for identification of nonproliferation not readily evident on ultra widefield color images, according to researchers at the Association for Research and Vision in Ophthalmology annual meeting.
Mydriatic phase-plate adjusted ultra-widefield (UWF) 200° retinal imaging and UWF fluorescein angiography (UWF-FA) were performed in 100 consecutive eyes with no evidence of panretinal laser or non-diabetic retinopathy retinal vascular disease.
The distribution of diabetic retinopathy (DR) severity using UWF images vs. UWF-FA was as follows: no DR, 28% vs. 3%; mild nonproliferative DR (NPDR), 18% vs. 32%; moderate NPDR, 27% vs. 18%; severe NPDR, 13% vs. 29%; proliferative DR (PDR), 11% vs. 15%; and high-risk PDR, 3% vs. 3%.
DR severity between UWF and UWF-FA images was within one step in 94% of eyes and exact in 46%, according to researchers. They found exact agreement in all eyes with PDR on UWF images.
Not one eye was graded more severe on UWF images than on UWF-FA.
UWF-FA identified more severe DR in 54% of all eyes and in 89.3%, 44.5%, 70.4% and 15.4% of eyes with no, mild, moderate and severe NPDR, according to the study.
Predominately peripheral lesions on UWF images were more common with increasing DR severity and were significantly associated with NP on UWF-FA, according to researchers.
NP on UWF-FA images was identified in 12.5% of eyes with mild NPDR, 55% moderate, 79.3% severe and 100% PDR.
UWF-FA may prove important for early identification of DR and refining the risk of DR progression and visual loss, according to researchers.
“In the past, the use of standard ETDRS-FA [Early Treatment Diabetic Retinopathy Study-FA] did not provide substantial clinical benefit in predicting DR progression as compared with ETDRS retinal photography,” Paolo S. Silva, MD, said in an interview with Primary Care Optometry News. “However, this study demonstrates that in eyes with less severe levels of DR, UWF-FA identifies more severe DR earlier and allows for identification of NP that is not readily evident on UWF color images.” – by Abigail Sutton
Reference: Rocha JT, et al. Comparison of diabetic retinopathy severity identified on ultra widefield retinal images and ultra-widefield fluorescein angiograms. Presented at: Association of Research in Vision and Ophthalmology annual meeting; May 7-11, 2017; Baltimore.
Disclosure: Rocha reports no relevant financial disclosures. Please see the abstract for remaining authors’ financial disclosures.