Price Liam D, Au Stephanie, Chong N Victor
Oxford Eye Hospital, University of Oxford, Oxford, UK.
University of Hong Kong, Hong Kong SAR, People's Republic of China.
Clin Ophthalmol. 2015 Mar 24;9:527-31. doi: 10.2147/OPTH.S79448. eCollection 2015.
To compare diabetic retinopathy (DR) severity grading between Optomap ultrawide field scanning laser ophthalmoscope (UWFSLO) 200° images and an Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard field view.
Optomap UWFSLO images (total: 266) were retrospectively selected for evidence of DR from a database of eye clinic attendees. The Optomap UWFSLO images were graded for DR severity by two masked assessors. An ETDRS seven-field mask was overlaid on the Optomap UWFSLO images, and the DR grade was assessed for the region inside the mask. Any interassessor discrepancies were adjudicated by a senior retinal specialist. Kappa agreement levels were used for statistical analysis.
Fifty images (19%) (P<0.001) were assigned a higher DR level in the Optomap UWFSLO view compared to the ETDRS seven-field view, which resulted in 40 images (15%) (P<0.001) receiving a higher DR severity grade. DR severity grades in the ETDRS seven-field view compared with the Optomap UWFSLO view were identical in 85% (226) of the images and within one severity level in 100% (266) of the images. Agreement between the two views was substantial: unweighted κ was 0.74±0.04 (95% confidence interval: 0.67-0.81) and weighted κ was 0.80±0.03 (95% confidence interval: 0.74-0.86).
Compared to the ETDRS seven-field view, a significant minority of patients are diagnosed with more severe DR when using the Optomap UWFSLO view. The clinical significance of additional peripheral lesions requires evaluation in future prospective studies using large cohorts.
比较Optomap超广角扫描激光检眼镜（UWFSLO）200°图像与糖尿病视网膜病变早期治疗研究（ETDRS）七标准视野下糖尿病视网膜病变（DR）的严重程度分级。
从眼科门诊患者数据库中回顾性选取Optomap UWFSLO图像（共266张）以寻找DR证据。由两名盲法评估者对Optomap UWFSLO图像的DR严重程度进行分级。将ETDRS七视野模板覆盖在Optomap UWFSLO图像上，并对模板内区域的DR分级进行评估。评估者之间的任何差异由一位资深视网膜专家进行判定。采用Kappa一致性水平进行统计分析。
与ETDRS七视野相比，50张图像（19%）（P<0.001）在Optomap UWFSLO视野下被判定为更高的DR水平，这使得40张图像（15%）（P<0.001）获得更高的DR严重程度分级。ETDRS七视野与Optomap UWFSLO视野下的DR严重程度分级在85%（226张）的图像中相同，在100%（266张）的图像中相差不超过一个严重程度级别。两种视野之间的一致性较高：未加权κ值为0.74±0.04（95%置信区间：[0.67, 0.81]），加权κ值为0.80±0.03（95%置信区间：[0.74, 0.86]）。
与ETDRS七视野相比，使用Optomap UWFSLO视野时，有相当少数的患者被诊断为更严重的DR。额外周边病变的临床意义需要在未来使用大型队列的前瞻性研究中进行评估。
