Ultra-Widefield Fundus Imaging May Improve DR Diagnostic Ability  

Ultra-widefield fundus imaging can improve diagnostic ability for detecting diabetic retinopathy.

Ultra-widefield fundus imaging may improve clinicians’ abilities to diagnose diabetic retinopathy (DR) and determine the condition’s severity, according to a study published in Eye. This technology may replace the Early Treatment Diabetic Retinopathy Study (ETDRS) 7-field imaging method that is currently used if future investigations continue to substantiate this claim, the report suggests.

Researchers compared and graded fundus examinations of 202 patients (69.3% men; mean age, 52.1 years) with DR using ERDRS 7-field and 2 different ultra-widefield fundus imaging devices. The team evaluated DR severity and visible retinal areas imaged by the 3 devices and noted the number and types of lesions outside of the ETDRS 7-field scope that were captured with the 2 ultra-widefield imaging methods. 

A comparison between the ETDRS 7-field and first ultra-widefield device showed moderate agreement between the 2 imaging methods (weighted K, 0.485; 95% CI, 0.421-0.523) for detecting DR severity, with exact matches in 59.3% (n=229) of eyes. Comparison between the ETDRS 7-field imaging and the second ultra-widefield device yielded an almost perfect agreement (weighted K, 0.924; 95% CI, 0.893–0.952), with 93.8% of eyes (n=362) showing an exact match. Comparing DR severity between the 2 ultra-widefield fundus imaging devices showed moderate agreement (weighted K, 0.461; 95% CI, 0.392–0.514) and exact matches in 57.3% of eyes.

[T]he standard ETDRS seven-field imaging procedure is time-consuming, and requires trained photographers and highly cooperative patients.

Relative visible retinal area was larger with the 2 ultra-widefield fundus imaging devices compared with ETDRS 7-field imaging, with a 7-field image occupying 53% of the relative visible retinal area of the 1 ultra-widefield device and between 33% and 75% for the second device according to the number of imaging montages.

In total, 2015 and 4200 peripheral lesions were detected in the first and second ultra-widefield fundus imaging devices, respectively (P < .001), suggesting more severe DR in approximately 10% and 12% of eyes, respectively, compared with ETDRS 7-field assessment. 

The investigators highlight the advantage of replacing the current ETDRS 7-field imaging method with ultra-widefield fundus imaging.

“[T]he standard ETDRS seven-field imaging procedure is time-consuming, and requires trained photographers and highly cooperative patients,” the study authors explain. “Additionally, it is limited to approximately the central posterior 75 degrees of the retina,
which represents approximately 30% of the entire retinal surface.”

Study limitations include a single center design, short study duration, and failure to obtain information pertaining to patients’ DR progression.


Xiao Y, Huang Z, Yuan Q, et al. Comparison of quantitative assessment and efficiency of diabetic retinopathy diagnosis using ETDRS seven-field imaging and two ultra-widefield imaging. Published online April 29, 2023. Eye (Lond). doi:10.1038/s41433023-02549-1