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Factors Affecting Predominantly Peripheral Lesion Identification and Grading.

Mohamed Ashraf^1,2, Abdulrahman Rageh¹, Michael Gilbert¹

¹Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.

Translational Vision Science & Technology

|June 8, 2021

Summary

Predominantly peripheral lesion (PPL) grading in diabetic retinopathy (DR) varies by assessment method, DR severity, and ultrawide field device. Optimizing quantitative thresholds improves agreement for accurate DR progression monitoring.

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Area of Science:

Ophthalmology
Medical Imaging
Diabetic Retinopathy Research

Background:

Ultrawide field color images (UWF-CIs) are crucial for assessing diabetic retinopathy (DR).
Predominantly peripheral lesions (PPLs) are key indicators of DR severity and progression.
Standardized grading of PPLs in UWF-CIs is essential but influenced by various factors.

Purpose of the Study:

To identify factors influencing Predominantly Peripheral Lesion (PPL) grading in ultrawide field color images (UWF-CIs).
To compare qualitative versus quantitative assessment methods for PPL grading.
To evaluate the impact of diabetic retinopathy (DR) severity and ultrawide field device type on PPL grading accuracy.

Main Methods:

Qualitative PPL grading was performed on UWF-CIs using standardized techniques.
Quantitative PPL grading involved individual annotation of hemorrhages/microaneurysms (H/MAs).
Data were collected from 791 eyes across two different ultrawide field devices.

Main Results:

Overall agreement between qualitative and quantitative PPL grading was moderate (ĸ = 0.423).
Agreement varied by DR severity, with fair agreement in mild nonproliferative DR (NPDR) and moderate agreement in moderate NPDR and severe NPDR-proliferative DR (PDR).
Device type impacted agreement, with poor agreement for mild NPDR on the 200Tx device (ĸ = 0.055).

Conclusions:

PPL determination differs between qualitative and quantitative grading methods.
DR severity, device type, and lesion count thresholds significantly affect PPL grading agreement.
These factors must be considered when evaluating DR progression rates using UWF imaging.