Quantifying early diabetic retinopathy

Howard-Williams, J.; Peckar, C O; Holman, R. R.; Bron, A. J.

doi:10.1007/bf00873213

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…The current assessment of diabetic retinopathy predominantly takes into account the type and number of lesions. However, several studies have shown that quantitative parameters such as the shape, size, location and dynamics of the lesions may contain important information for the assessment of disease progression (Howard‐Williams et al 1986; Bek & Helgesen 2001). A detailed quantitative analysis of these parameters has become feasible with the advent of computerized image analysis.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of retinopathy in type 2 diabetes: identification of prognostic parameters for developing visual loss secondary to diabetic maculopathy

Hove¹,

Kristensen²,

Lauritzen³

et al. 2004

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To describe whether quantitative assessment of early changes in the morphology of retinopathy lesions can predict development of vision-threatening diabetic maculopathy. Methods: We used a nested case-control study, and we studied 11 type 2 diabetes patients who had developed visual loss secondary to diabetic maculopathy. For each diabetes patient, we also studied three matched control patients who had been followed for a comparable period of time without developing visual loss. Fundus photographs describing the early development of retinopathy were digitized and subjected to a full manual quantitative grading on a computer monitor. Differences in the early development of retinal morphology were compared between the two groups. The outcome parameters were changes in the number and area of haemorrhages and exudates in different regions of the fundus, and the weighted distance of these lesions from the fovea and the optic disc. Results: In patients who developed visual loss secondary to diabetic maculopathy there was significant early progression in the total area and number of haemorrhages and exudates. The haemorrhages had progressed in all retinal areas except the area around the optic disc and the temporal vascular arcades. The exudates had progressed temporally from the fovea and in the retinal periphery. Conclusions:The results suggest that a quantitative description of the regional development of early diabetic retinopathy may help in identifying patients who will later develop vision-threatening maculopathy.

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Section: Introductionmentioning

confidence: 99%

Quantitative analysis of retinopathy in type 2 diabetes: identification of prognostic parameters for developing visual loss secondary to diabetic maculopathy

Hove¹,

Kristensen²,

Lauritzen³

et al. 2004

Acta Ophthalmologica Scandinavica

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“…In our experience and in other published studies, fluorescein angiography doubles the frequency of diagnosis of diabetic retinopathy [5,6]. Therefore, I disagree with Howard-Williams et al [1], who state that a precise means of assessing colour photographs may be as effective as fluorescein angiography. In fact, it is paradoxical that in many cases fluorescein angiography (a sensitive method) is only performed for patients who already have evidence of retinal lesions by normal ophthalmoscopy (a less sensitive method), so that the initial abnormalities of diabetic retinopathy may not be diagnosed for several years.…”

Section: Early Diabetic Retinopathymentioning

confidence: 57%

“…In their paper entitled "Quantifying early diabetic retinopathy", Howard-Williams et al [1] have proposed a new method of quantifying diabetic retinopathy on standardised retinal colour photographs. Since 1943, when Ballantyne and Loewenstein [2] showed that microaneurysms were the early, specific lesions of diabetic retinopathy, approximately 30 classifications of diabetic retinopathy viewed by regular ophthalmoscopy have been described.…”

Section: Early Diabetic Retinopathymentioning

confidence: 99%

Early diabetic retinopathy

Dorchy

1987

Diabetologia

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“…However, those that are found are predominantly located in the posterior pole. They appear to have a predisposition for the area temporal to the fovea (Howard-Williams et al 1986;Kern & Engerman 1995;Stitt et al 1995) This might reflect the higher metabolic activity of this retinal area as demonstrated by blood flow rates in this area (Alm & Bill 1973;Rassam et al 1996). Furthermore, the plasmaskimming phenomenon may be of importance (Gaehtgens 1981).…”

Section: Discussionmentioning

confidence: 99%

“…Furhermore, one macula-centred 60ae field covered most of the standard fields 1-5, which are considered to be the fields of importance when looking for early retinopathy (Howard-Williams et al 1986;Kern & Engerman 1995;Stitt et al 1995), as well as neovascularisations (Moss et al 1989).…”

Section: Discussionmentioning

confidence: 99%

A comparison between one‐ and two‐field 60° fundus photography when screening for diabetic retinopathy

Wendt¹,

Rönnholm²,

Heikkilä³

et al. 2000

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To compare the severity level of diabetic retinopathy obtained when assessed from two versus only one 60ae photographic field using colour transparencies and red-free, black-and-white photographs. To compare the areal coverage of these two photographic strategies to that of seven-field 30ae photography. Methods: Two ophthalmologists graded photographs of 74 eyes of 74 type I and II diabetes patients. Inter-method agreement was expressed in percentages and using kappa statistics and scatter-diagrams. The comparison of the approximate photographic areal coverage was done from diagrams using planimetry. Results: The severity level of retinopathy when judged from two photographic fields was more severe in 13.5% (Grader 1) and in 16.2% (Grader 2) from colour transparencies and in 13.5% (Grader 1) and in 14.9% (Grader 2) from red-free black-and-white prints, as compared to assessments from only one field. Kappa values (0.84-0.86) for inter-method agreement for five pooled retinopathy levels revealed good agreement. Neither grader missed retinopathy requiring clinical assessment or treatment (levels Ø47) when minimal retinopathy (levels 14-20) was detected using only one 60ae colour slide or red-free photograph. A second optic disc-centred field provided valuable additional information when more severe retinopathy lesions (levels Ø30) were detected in the macula-centred field. One macula-centred 60ae photograph covered 60% and two 60ae photographs 80% of the area covered by seven-field 30ae photography. Two-field 60ae photography covers areas left outside seven-field 30ae photography. Conclusion:We propose the use of one macula-centred 60ae photograph when screening for the first lesions of diabetic retinopathy. After they have been found two-field 60ae photography is recommended.

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Quantifying early diabetic retinopathy

Cited by 5 publications

References 14 publications

Quantitative analysis of retinopathy in type 2 diabetes: identification of prognostic parameters for developing visual loss secondary to diabetic maculopathy

Quantitative analysis of retinopathy in type 2 diabetes: identification of prognostic parameters for developing visual loss secondary to diabetic maculopathy

Early diabetic retinopathy

A comparison between one‐ and two‐field 60° fundus photography when screening for diabetic retinopathy

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