Comparison of montage with conventional stereoscopic seven‑field photographs for assessment of ETDRS diabetic retinopathy severity

Authors

Nam V. Nguyen, Stanford University & Ocular Imaging Research and Reading Center & University of Nebraska-Lincoln
Erin M. Vigil, Stanford University & Ocular Imaging Research and Reading Center & University of Texas Southwestern School of Medicine
Muhammad Hassan, Stanford University
Muhammad S. Halim, Stanford University
Sean C. Baluyot, Ocular Imaging Research and Reading Center
Hugo A. Guzman, Ocular Imaging Research and Reading Center
Rubbia Afridi, Stanford University
Diana V. Do, Stanford University
Yasir J. Sepah, Stanford UniversityFollow

ORCID IDs

http://orcid.org/0000-0002-0104-6284

Date of this Version

11-13-2019

Citation

The Author(s) 2019

Comments

Nguyen et al. Int J Retin Vitr (2019) 5:51 https://doi.org/10.1186/s40942-019-0201-z

Abstract

Background: The ETDRS stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials. To the best of our knowledge, the comparison between montage and stereoscopic 7F has not been reported in the literature. Therefore, the main purpose of this study is to compare agreement between montage and stereoscopic seven-field (7F) photographs in the assessment of DR severity.

Methods: Stereoscopic 7F photographs were captured from subjects with DR. Montages of monoscopic 7F images were created using Adobe Photoshop CS6 Extended©. The best quality image of each stereo pair was selected and placed on a 150 × 125-inch canvas field according to the standard location from field 1 to 7. All the fields were aligned following the vessels and overlaid using the built-in blending tool. The resulting montage was utilized for grading and compared with grading on stereoscopic 7F photographs. Three independent graders were asked to assess DR severity on stereoscopic 7F photographs and montage. Severity level agreement between stereo 7F and montage was crosstabulated and the agreement of DR severity levels between stereoscopic 7-field images and montage was analyzed using κ intergrader agreement; statistical significance was set at p < 0.05.

Results: A total of 50 eyes were included in the study. There was a substantial agreement between stereoscopic 7F and montage (κ = 0.745, κweighted = 0.867) in assessment of DR severity. Of 50 eyes, 80% of the cases showed complete agreement, and 100% of the cases had agreement within one-step. There was a moderate agreement among graders, and κ-value ranged from 0.4705 to 0.5803.

Conclusion: In this study, we found a substantial agreement in assessing DR severity score employing non-stereoscopic montage and stereoscopic 7F photographs.