Comparison of Subjective Assessment and Precise Quantitative Assessment of Lesion Distribution in Diabetic Retinopathy
Comparison of Subjective Assessment and Precise Quantitative Assessment of Lesion Distribution in Diabetic Retinopathy
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DOI：
10.1001/jamaophthalmol.2018.0070
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发表时间：
2018-04-01
影响因子：
8.1
通讯作者：
Sadda, SriniVas R.
中科院分区：
文献类型：
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作者：
Sears, Connie Martin;Nittala, Muneeswar G.;Sadda, SriniVas R.
重要性：非增殖性糖尿病视网膜病变（DR）的眼部主要外周病变被认为是发展为增殖性疾病的潜在危险因素。然而，评估病变分布的可靠性和最佳方法仍不确定。目的比较超宽视场（UWF）病变负担主观评估与精确量化的一致性。设计、设置和参与者本多地点横断面研究检查了2014年12月20日至2014年8月1日从DR筛查临床患者获得的UWF假彩色图像。104例中，161只眼伴DR。数据分析于2016年6月1日至2016年12月1日在Doheny图像阅读中心进行。主观上和定量地评估眼睛DR病变的分布，并将眼睛分为以中心病变为主（PCLs）或以周围病变为主（ppl）。量化各类型病变的频率和表面面积（SA）。比较了综合分类和主观分类与定量分类的一致程度。并比较了几种测定PPL分布的方法。结果经评分者主观频率评价，133只眼被分类为有屈光性近视，28只眼被分类为有屈光性近视。准确定量病变SA后，121眼诊断为PCL， 40眼诊断为PPL。在基于sa的量化中，134只眼被分类为PCL， 27只眼被分类为PPL。基于频率的方法（平均差值[SD]: PCL， 6 [1]； PPL, 13 [6], P < 0.001）和基于sa的方法（平均差值[SD]: PCL， 6 [1]； PPL, 20 [7], P < 0.001）对DR病变分布的定性和定量分类有显著差异。在基于频率的分类中，积分的可重复性和主观与定量的一致性都更高。结论和相关性在某些情况下，对UWF图像上PPL DR病变的主观评估与精确的定量评估不同，特别是在考虑病变面积时。这些发现强调了客观定量的DR评估方法的好处，这可能有助于开发更精确的DR评分系统。
IMPORTANCE Predominantly peripheral disease in eyes with nonproliferative diabetic retinopathy (DR) is suggested as a potential strong risk factor for progression to proliferative disease. However, the reliability and optimal method for the assessment of lesion distribution are still uncertain.OBJECTIVE To compare agreement between subjective assessment and precise quantification of lesion burden in ultrawidefield (UWF) images of eyes with DR.DESIGN, SETTING, AND PARTICIPANTS This multisite cross-sectional study examines UWF pseudocolor images acquired from DR screening clinic patients from December 20, 2014, through August 1, 2014. Of 104 cases, 161 eyes with DR were included. Data analysis was conducted from June 1, 2016, through December 1, 2016, at the Doheny Image Reading Center.MAIN OUTCOMES AND MEASURES Distribution of DR lesions in eyes was assessed subjectively and quantitatively, and eyes were classified as having predominantly central lesions (PCLs) or predominantly peripheral lesions (PPLs). The frequency and surface area (SA) of each lesion type were quantified. Intergrader and subjective vs quantitative classification were compared for level of agreement. Several methods of determining PPL distribution were also compared.RESULTS On subjective frequency-based evaluation by graders, 133 eyes were classified as having PCL, and 28 eyes as having PPL. On exact quantification of lesion SA, 121 eyes were classified as PCL, and 40 eyes as having PPL. On SA-based quantification, 134 eyes were classified as having PCL, and 27 eyes as having PPL. There was a significant difference between qualitative and quantitative classification of DR lesion distribution for both frequency-based (mean difference [SD]: PCL, 6 [2]; PPL, 13 [6]; P < .001) and SA-based (mean difference [SD]: PCL, 6 [1]; PPL, 20 [7]; P < .001) methods. Both intergrader reproducibility and subjective vs quantitative agreement were higher with frequency-based classification.CONCLUSIONS AND RELEVANCE Subjective assessment of PPL DR lesions on UWF images differed in some cases from precise quantitative assessments, particularly when considering the area of lesions. These findings highlight the benefit of objective quantitative approaches to DR assessment, which may facilitate the development of a more precise DR scoring system.