Research Article
No access
Published Online: 5 June 2012

Automated Retinal Imaging System (ARIS) Compared with ETDRS Protocol Color Stereoscopic Retinal Photography to Assess Level of Diabetic Retinopathy

Publication: Diabetes Technology & Therapeutics
Volume 14, Issue Number 6

Abstract

Background: Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard-field color stereoscopic retinal photography (ETDRS photos) has been a gold standard for determining diabetic retinopathy (DR) severity. The Automated Retinal Imaging System (ARIS™, model 110, Visual Pathways, Inc., Prescott, AZ) acquires seven-sequential color stereoscopic digital images (ARIS images) by a semiautomated technician-run process generally corresponding to ETDRS photos. We assessed the correlation between a single semiautomated ARIS imaging session without any re-imaging and ETDRS photos performed by a certified photographer for the determination of DR severity.
Methods: Two independent masked readers graded mydriatic ARIS images and ETDRS photos. A third masked retinal specialist adjudicated discrepancies. Correlation between the two modalities was compared using weighted-κ statistics.
Results: We evaluated 211 eyes of 106 patients with varying levels of DR. Partially ungradable images were present in 3.4% of ETDRS photos versus 31.8% of ARIS images. Exact agreement and agreement within one level between ETDRS photos and ARIS images using only completely gradable image sets occurred in 69% (κ=0.81) and 90% of cases, respectively. Exact agreement for clinically significant macular edema was 92.1% (κ=0.59). There was 100% agreement for eyes with high-risk proliferative DR. Within one level of DR severity, 100% agreement occurred for the following: questionable nonproliferative DR (NPDR), moderate NPDR, and severe NPDR.
Conclusions: Results suggest that semiautomated ARIS images compare favorably with ETDRS photos when full image sets can be obtained; however, partially ungradable image sets occurred almost 10 times more frequently with ARIS images than with ETDRS photos. In the two-thirds of cases where ARIS images can be utilized, ARIS can obtain retinal images comparable to ETDRS photos while requiring less highly trained personnel than generally needed for standard ETDRS photos.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research GroupOphthalmology199198786-806. 1. Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:786–806.
2.
Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research GroupOphthalmology199198823-833. 2. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:823–833.
3.
Tennant MTGreve MDRudnisky CJHillson TRHinz BJ. Identification of diabetic retinopathy by stereoscopic digital imaging via teleophthalmology: a comparison to slide filmCan J Ophthalmol200136187-196. 3. Tennant MT, Greve MD, Rudnisky CJ, Hillson TR, Hinz BJ: Identification of diabetic retinopathy by stereoscopic digital imaging via teleophthalmology: a comparison to slide film. Can J Ophthalmol 2001;36:187–196.
4.
Ahmed JWard TPBursell SEAiello LMCavallerano JDVigersky RA. The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathyDiabetes Care2006292205-2209. 4. Ahmed J, Ward TP, Bursell SE, Aiello LM, Cavallerano JD, Vigersky RA: The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy. Diabetes Care 2006;29:2205–2209.
5.
Vujosevic SBenetti EMassignan FPilotto EVarano MCavarzeran FAvogaro AMidena E. Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fieldsAm J Ophthalmol2009148111-118. 5. Vujosevic S, Benetti E, Massignan F, Pilotto E, Varano M, Cavarzeran F, Avogaro A, Midena E: Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields. Am J Ophthalmol 2009;148:111–118.
6.
Chow SPAiello LMCavallerano JDKatalinic PHock KTolson AKirby RBursell SEAiello LP. Comparison of nonmydriatic digital retinal imaging versus dilated ophthalmic examination for nondiabetic eye disease in persons with diabetesOphthalmology2006113833-840. 6. Chow SP, Aiello LM, Cavallerano JD, Katalinic P, Hock K, Tolson A, Kirby R, Bursell SE, Aiello LP: Comparison of nonmydriatic digital retinal imaging versus dilated ophthalmic examination for nondiabetic eye disease in persons with diabetes. Ophthalmology 2006;113:833–840.
7.
Cavallerano JDAiello LPCavallerano AAKatalinic PHock KKirby RAiello LM. Joslin Vision Network Clinical Team: Nonmydriatic digital imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathyAm J Ophthalmol2005140667-673. 7. Cavallerano JD, Aiello LP, Cavallerano AA, Katalinic P, Hock K, Kirby R, Aiello LM; Joslin Vision Network Clinical Team: Nonmydriatic digital imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathy. Am J Ophthalmol 2005;140:667–673.
8.
Li HKHubbard LDDanis RPEsquivel AFlorez-Arango JFKrupinski EA. Monoscopic versus stereoscopic retinal photography for grading diabetic retinopathy severityInvest Ophthalmol Vis Sci2010513184-3192. 8. Li HK, Hubbard LD, Danis RP, Esquivel A, Florez-Arango JF, Krupinski EA: Monoscopic versus stereoscopic retinal photography for grading diabetic retinopathy severity. Invest Ophthalmol Vis Sci 2010;51:3184–3192.
9.
Nayak JBhat PSAcharya RLim CMKagathi M. Automated identification of diabetic retinopathy stages using digital fundus imagesJ Med Syst200832107-115. 9. Nayak J, Bhat PS, Acharya R, Lim CM, Kagathi M: Automated identification of diabetic retinopathy stages using digital fundus images. J Med Syst 2008;32:107–115.
10.
Rudnisky CJTennant MTWeis ETing AHinz BJGreve MD. Web-based grading of compressed stereoscopic digital photography versus standard slide film photography for the diagnosis of diabetic retinopathyOphthalmology20071141748-1754. 10. Rudnisky CJ, Tennant MT, Weis E, Ting A, Hinz BJ, Greve MD: Web-based grading of compressed stereoscopic digital photography versus standard slide film photography for the diagnosis of diabetic retinopathy. Ophthalmology 2007;114:1748–1754.
11.
Massin PErginay ABen Mehidi AVicaut EQuentel GVictor ZMarre MGuillausseau PJGaudric A. Evaluation of a new non-mydriatic digital camera for detection of diabetic retinopathyDiabet Med200320635-641. 11. Massin P, Erginay A, Ben Mehidi A, Vicaut E, Quentel G, Victor Z, Marre M, Guillausseau PJ, Gaudric A: Evaluation of a new non-mydriatic digital camera for detection of diabetic retinopathy. Diabet Med 2003;20:635–641.
12.
Landis JRKoch GG. The measurement of observer agreement for categorical dataBiometrics197733159-174. 12. Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.
13.
Li HKHorton MBursell SECavallerano JZimmer-Galler ITennant MAbramoff MChaum EDebuc DCLeonard-Martin TWinchester M. American Telemedicine Association Diabetic Retinopathy Telehealth Practice Recommendations Working Group: Telehealth practice recommendations for diabetic retinopathy, second editionTelemed J E Health201117814-837. 13. Li HK, Horton M, Bursell SE, Cavallerano J, Zimmer-Galler I, Tennant M, Abramoff M, Chaum E, Debuc DC, Leonard-Martin T, Winchester M; American Telemedicine Association Diabetic Retinopathy Telehealth Practice Recommendations Working Group: Telehealth practice recommendations for diabetic retinopathy, second edition. Telemed J E Health 2011;17:814–837.
14.
Cavallerano AACavallerano JDKatalinic PBlake BRynne MConlin PRHock KTolson AMAiello LPAiello LM. Joslin Vision Network Research Team: A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center—the Joslin Vision Network Eye Health Care ModelAm J Ophthalmol2005139597-604. 14. Cavallerano AA, Cavallerano JD, Katalinic P, Blake B, Rynne M, Conlin PR, Hock K, Tolson AM, Aiello LP, Aiello LM; Joslin Vision Network Research Team: A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center—the Joslin Vision Network Eye Health Care Model. Am J Ophthalmol 2005;139:597–604.
15.
Choremis JChow DR. Use of telemedicine in screening for diabetic retinopathyCan J Ophthalmol200338575-579. 15. Choremis J, Chow DR: Use of telemedicine in screening for diabetic retinopathy. Can J Ophthalmol 2003;38:575–579.
16.
Higgs ERHarney BAKelleher AReckless JP. Detection of diabetic retinopathy in the community using a non-mydriatic cameraDiabet Med19918551-555. 16. Higgs ER, Harney BA, Kelleher A, Reckless JP: Detection of diabetic retinopathy in the community using a non-mydriatic camera. Diabet Med 1991;8:551–555.
17.
Cicchetti DVFeinstein AR. High agreement but low kappa: II. Resolving the paradoxesJ Clin Epidemiol199043551-558. 17. Cicchetti DV, Feinstein AR: High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol 1990;43:551–558.
18.
Bursell SECavallerano JDCavallerano AAClermont ACBirkmire-Peters DAiello LPAiello LM. Joslin Vision Network Research Team: Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathyOphthalmology2001108572-585. 18. Bursell SE, Cavallerano JD, Cavallerano AA, Clermont AC, Birkmire-Peters D, Aiello LP, Aiello LM; Joslin Vision Network Research Team: Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy. Ophthalmology 2001;108:572–585.
19.
Rudnisky CJTennant MTde Leon ARHinz BJGreve MD. Benefits of stereopsis when identifying clinically significant macular edema via teleophthalmologyCan J Ophthalmol200641727-732. 19. Rudnisky CJ, Tennant MT, de Leon AR, Hinz BJ, Greve MD: Benefits of stereopsis when identifying clinically significant macular edema via teleophthalmology. Can J Ophthalmol 2006;41:727–732.
20.
Bresnick GHMukamel DBDickinson JCCole DR. A screening approach to the surveillance of patients with diabetes for the presence of vision-threatening retinopathyOphthalmology200010719-24. 20. Bresnick GH, Mukamel DB, Dickinson JC, Cole DR: A screening approach to the surveillance of patients with diabetes for the presence of vision-threatening retinopathy. Ophthalmology 2000;107:19–24.

Information & Authors

Information

Published In

cover image Diabetes Technology & Therapeutics
Diabetes Technology & Therapeutics
Volume 14Issue Number 6June 2012
Pages: 515 - 522
PubMed: 22385213

History

Published online: 5 June 2012
Published in print: June 2012
Published ahead of print: 2 March 2012

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Manvi P. Maker
*
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Jason Noble
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Paolo S. Silva
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Jerry D. Cavallerano
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Timothy J. Murtha
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Jennifer K. Sun
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Lloyd M. Aiello
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Sven-Erik Bursell
Telehealth Research Institute, University of Hawaii, Honolulu, Hawaii.
Lloyd Paul Aiello
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

Notes

Address correspondence to:Paolo S. Silva, M.D.Beetham Eye InstituteJoslin Diabetes Center1 Joslin PlaceBoston, MA 02215E-mail: [email protected]

Author Disclosure Statement

No competing financial interests exist.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top