Evidence mapPaperPMID 39227901Full record

ArticleBMC ophthalmology2024

ETDRS grading with CLARUS ultra-widefield images shows agreement with 7-fields colour fundus photography.

Ana Rita Santos, Sejal Ghate, Marta Lopes, Ana Cláudia Rocha, Torcato Santos, Débora Reste-Ferreira, Niranchana Manivannan, Katharina Foote, José Cunha-Vaz

Abstract read
In one paragraph

Article in BMC ophthalmology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Ana Rita SantosAIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal. arsantos@aibili.pt.
Sejal GhateCarl Zeiss Meditec, Inc, Dublin, CA, USA.
Marta LopesAIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.
Ana Cláudia RochaAIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.
Torcato SantosAIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.
Débora Reste-FerreiraAIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.
Niranchana ManivannanCarl Zeiss Meditec, Inc, Dublin, CA, USA.
Katharina FooteCarl Zeiss Meditec, Inc, Dublin, CA, USA.
José Cunha-VazAIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo analyse and compare the grading of diabetic retinopathy (DR) severity level using standard 35° ETDRS 7-fields photography and CLARUS™ 500 ultra-widefield imaging system.

methodsA cross-sectional analysis of retinal images of patients with type 2 diabetes (n = 160 eyes) was performed for this study. All patients underwent 7-fields colour fundus photography (CFP) at 35° on a standard Topcon TRC-50DX

resultsImages of 160 eyes from 83 diabetic patients were considered for analysis. According to the 35° ETDRS 7-fields images, 22 eyes were evaluated as DR severity level 10-20, 64 eyes were evaluated as DR level 35, 41 eyes level 43, 21 eyes level 47, 7 eyes level 53, and 5 eyes level 61. The same DR severity level was achieved with CLARUS 500 UWF images in 92 eyes (57%), showing a perfect agreement (k > 0.80) with the 7-fields 35° technique. Fifty-seven eyes (36%) showed a higher DR level with CLARUS UWF images, mostly due to a better visualization of haemorrhages and a higher detection rate of intraretinal microvascular abnormalities (IRMA). Only 11 eyes (7%) showed a lower severity level with the CLARUS UWF system, due to the presence of artifacts or media opacities that precluded the correct evaluation of DR lesions.

conclusionsUWF CLARUS 500 device showed nearly perfect agreement with standard 35° 7-fields images in all ETDRS severity levels. Moreover, CLARUS images showed an increased ability to detect haemorrhages and IRMA helping with finer evaluation of lesions, thus demonstrating that a UWF photograph can be used to grade ETDRS severity level with a better visualization than the standard 7-fields images.

trial registrationApproved by the AIBILI - Association for Innovation and Biomedical Research on Light and Image Ethics Committee for Health with number CEC/009/17- EYEMARKER.

Indexed as

Diabetes Mellitus, Type 2Diabetic RetinopathyPhotographySeverity of Illness IndexAdultAgedCross-Sectional StudiesDiagnostic Techniques, OphthalmologicalFemaleFundus OculiHumansMaleMiddle AgedReproducibility of ResultsCLARUSColour fundus photographyDiabetic retinopathyETDRS severity scaleUltra-widefield imaging

Identifiers

PMID39227901
PMCPMC11369991

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.