Sensitivity and specificity of pseudocolor ultrawide field imaging in comparison to wide field fundus fluorescein angiography in detecting retinal neovascularization in diabetic retinopathy

Objective To evaluate the diagnostic accuracy of ultrawide pseudocolor retinal photography (pseudocolor UWF) compared to wide field fundus fluorescein angiography (WFFFA) in the detection of retinal neovascularization (NV) and NV of the disc (NVD) in patients with diabetic retinopathy (DR). Design Diagnostic accuracy observational study evaluating pseudocolor UWF as the index test. The reference standard was WFFFA. Setting Single retinal centre in India. Participants People with severe non-proliferative DR (sNPDR), early proliferative DR (ePDR) or high-risk proliferative DR (HR PDR). Main outcome measures Sensitivity and specificity of pseudocolor UWF in the detection of NV. Results A total of 176 eyes of 94 subjects with sNPDR, ePDR or HR PDR underwent pseudocolor UWF and WFFFA. The sensitivity and specificity of pseudocolor UWF in detecting NVE were 92.5% (95% CI 86.2-96.5) and 81% (95% CI 64.8-92.0), respectively, with moderate interobserver agreement of 0.722 (p value 0.001). The positive predictive value and negative predictive value were 83.0 (71.4-90.5) and 91.5 (84.9-95.3), respectively. Conclusion Compared to WFFFA as the gold standard, pseudocolor UWF has high sensitivity and specificity in detection of NV in all retinal quadrants and NVD. Therefore, pseudocolor UWF may be used as a non-invasive tool for screening and managing DR.