Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02215, USA.
Diabetes Technol Ther. 2012 Jun;14(6):515-22. doi: 10.1089/dia.2011.0270. Epub 2012 Mar 2.
Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard-field color stereoscopic retinal photography (ETDRS photos) has been a gold standard for determining diabetic retinopathy (DR) severity. The Automated Retinal Imaging System (ARIS™, model 110, Visual Pathways, Inc., Prescott, AZ) acquires seven-sequential color stereoscopic digital images (ARIS images) by a semiautomated technician-run process generally corresponding to ETDRS photos. We assessed the correlation between a single semiautomated ARIS imaging session without any re-imaging and ETDRS photos performed by a certified photographer for the determination of DR severity.
Two independent masked readers graded mydriatic ARIS images and ETDRS photos. A third masked retinal specialist adjudicated discrepancies. Correlation between the two modalities was compared using weighted-κ statistics.
We evaluated 211 eyes of 106 patients with varying levels of DR. Partially ungradable images were present in 3.4% of ETDRS photos versus 31.8% of ARIS images. Exact agreement and agreement within one level between ETDRS photos and ARIS images using only completely gradable image sets occurred in 69% (κ=0.81) and 90% of cases, respectively. Exact agreement for clinically significant macular edema was 92.1% (κ=0.59). There was 100% agreement for eyes with high-risk proliferative DR. Within one level of DR severity, 100% agreement occurred for the following: questionable nonproliferative DR (NPDR), moderate NPDR, and severe NPDR.
Results suggest that semiautomated ARIS images compare favorably with ETDRS photos when full image sets can be obtained; however, partially ungradable image sets occurred almost 10 times more frequently with ARIS images than with ETDRS photos. In the two-thirds of cases where ARIS images can be utilized, ARIS can obtain retinal images comparable to ETDRS photos while requiring less highly trained personnel than generally needed for standard ETDRS photos.
早期治疗糖尿病性视网膜病变研究（ETDRS）的七标准场彩色立体视网膜摄影（ETDRS 照片）一直是确定糖尿病性视网膜病变（DR）严重程度的金标准。自动化视网膜成像系统（ARIS™，型号 110，视觉通路公司，亚利桑那州普雷斯科特）通过半自动技术人员操作的过程获取七个连续的彩色立体数字图像（ARIS 图像），该过程通常与 ETDRS 照片相对应。我们评估了单次半自动 ARIS 成像过程（无需任何重新成像）与由认证摄影师进行的 ETDRS 照片在确定 DR 严重程度方面的相关性。
两名独立的掩蔽读者对散瞳 ARIS 图像和 ETDRS 照片进行分级。第三位掩蔽的视网膜专家对差异进行裁决。使用加权κ统计比较两种模式之间的相关性。
我们评估了 106 名患者的 211 只眼，这些患者的 DR 程度不同。部分无法分级的图像在 ETDRS 照片中占 3.4%，而在 ARIS 图像中占 31.8%。仅使用完全可分级图像集，ETDRS 照片和 ARIS 图像之间的完全一致和一致程度分别为 69%（κ=0.81）和 90%。临床上显著黄斑水肿的完全一致率为 92.1%（κ=0.59）。高危增殖性 DR 眼的一致性为 100%。在 DR 严重程度相差一个等级的情况下，以下情况的一致性为 100%：可疑非增殖性 DR（NPDR）、中度 NPDR 和重度 NPDR。
结果表明，当可以获得完整的图像集时，半自动 ARIS 图像与 ETDRS 照片相比表现良好；然而，ARIS 图像的部分不可分级图像集的发生率比 ETDRS 照片高近 10 倍。在 ARIS 图像可用于三分之二的情况下，ARIS 可以获得与 ETDRS 照片相当的视网膜图像，而所需的人员培训水平低于通常用于标准 ETDRS 照片的人员培训水平。
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