Accuracy of ultra-wide field fundus photography for identifying diabetic retinal neovascularization compared to fluorescein angiography

Abstract

Purpose

To evaluate the efficacy of ultrawide field fundus photography (UWFFP) in detecting diabetic neovascularization, with a comparative analysis against ultrawide field fluorescein angiography (UWFFA).

Methods

A retrospective cross-sectional study was conducted using images from 100 eyes of 62 treatment-naïve patients with proliferative diabetic retinopathy (PDR), all of whom underwent both UWFFP and UWFFA on the same day. Two masked graders independently evaluated the UWFFP images to identify neovascular lesions, which were categorized into three predefined anatomical zones: neovascularization of the disc (NVD), neovascularization of the mid-periphery (NV-MP; within 10 mm of the fovea), and neovascularization of the far periphery (NV-FP; beyond 10 mm from the fovea). The findings were subsequently compared with those obtained from UWFFA. Sensitivity and specificity analyses were conducted to evaluate differences in detection rates between the two methods.

Results

UWFFP detected NVD and NV-MP effectively, with the highest specificity for NVD (98.2%) and a high sensitivity for NV-MP (90.2%). Strong agreement with UWFFA was observed for NVD (κ = 0.83) and moderate agreement for NV-MP (κ = 0.65). However, UWFFP had lower sensitivity for NV-FP (56.5%) and only moderate agreement (κ = 0.52). McNemar's test showed UWFFA had significantly higher detection rates for NV-FP (46% vs. 29%, p < 0.001).

Conclusion

UWFFP is a valuable tool for identifying neovascularization associated with diabetic retinopathy in the optic disc and mid-peripheral retina. However, UWFFA remains the superior modality for reliable assessment, particularly in detecting peripheral neovascularization.