Comparative detection of diabetic retinopathy microvascular lesions using single-capture ultrawide-field swept-source OCT angiography versus widefield colour fundus photography.

@article{asad2026comparative,
  title = {{Comparative detection of diabetic retinopathy microvascular lesions using single-capture ultrawide-field swept-source OCT angiography versus widefield colour fundus photography.}},
  author = {Yusra Asad and Pavan Paniharam and Ser Koon Goh and Ayush Jayakrishnan and Wenjun Song and Jun Ting Yeo and Ryan Zheng Hui Lee and Caitlin Loh and Wei Hing Seah and Ryan Zi Lin Tan and Lingyi Zhuang and Pei Qi Lo and Tai Yong Loh and Juling Sia and Jia Jia Mah and Ying Jie Yong and Nicola Gan and Rupesh Agrawal and Min Wang and Sandy Wenting Zhou},
  journal = {BMC ophthalmology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12886-026-05158-0},
  url = {https://europepmc.org/article/MED/42928188},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Comparative detection of diabetic retinopathy microvascular lesions using single-capture ultrawide-field swept-source OCT angiography versus widefield colour fundus photography.
AU  - Yusra Asad
AU  - Pavan Paniharam
AU  - Ser Koon Goh
AU  - Ayush Jayakrishnan
AU  - Wenjun Song
AU  - Jun Ting Yeo
AU  - Ryan Zheng Hui Lee
AU  - Caitlin Loh
AU  - Wei Hing Seah
AU  - Ryan Zi Lin Tan
AU  - Lingyi Zhuang
AU  - Pei Qi Lo
AU  - Tai Yong Loh
AU  - Juling Sia
AU  - Jia Jia Mah
AU  - Ying Jie Yong
AU  - Nicola Gan
AU  - Rupesh Agrawal
AU  - Min Wang
AU  - Sandy Wenting Zhou
PY  - 2026
DA  - 2026/07/25
JO  - BMC ophthalmology
DO  - 10.1186/s12886-026-05158-0
UR  - https://europepmc.org/article/MED/42928188
AB  - Background  To compare the detection and quantification of intraretinal microvascular abnormalities (IRMAs) and neovascularization (NV) between widefield colour fundus photography (WF CFP) and single-capture ultrawide-field swept-source OCT angiography (UWF SS-OCTA) across diabetic retinopathy (DR) severity stages, and to evaluate whether paired multimodal review enhances lesion detection and disease classification.Methods  Eyes of different DR stages were imaged using 133° WF CFP and 150° UWF OCTA imaging modalities. Images were independently graded by masked, trained graders for the presence and quantification of NVs and IRMAs. Paired multimodal review was then performed bidirectionally for WF CFP and UWF OCTA to assess whether lesion detection could be improved by cross-referencing the corresponding image from the other modality. Intergrader agreement and inter-modality agreement during independent and paired multimodal review were assessed using intraclass correlation coefficients (ICC).Results  A total of 120 eyes were analysed (NPDR: 64.6%; PDR: 35.4%). Under independent grading, UWF OCTA detected significantly more lesions than WF CFP across all DR stages (all p < 0.001), with poor inter-modality agreement. Paired multimodal review significantly increased WF CFP lesion counts across all groups (all p < 0.001), while UWF OCTA counts remained unchanged or showed no significant increase. Inter-modality agreement improved after paired review (mild-moderate NPDR IRMA ICC: 0.219; severe NPDR IRMA ICC: 0.334; PDR NV ICC: 0.726), however, UWF OCTA continued to detect significantly more lesions (all p < 0.001). Inter-grader agreement for both NV and IRMA grading was higher for UWF OCTA than WF CFP (NV ICC: 0.974 vs. 0.694; IRMA ICC: 0.635 vs. 0.420). In an exploratory finding, 12 eyes (10%) were reclassified from NPDR to PDR following multimodal review.Conclusions  Single-capture UWF OCTA detects significantly more IRMAs and NV than WF CFP, with superior reproducibility. Multimodal review enhances lesion recognition on WF CFP but does not eliminate inter-modality discrepancies. These findings highlight the potential of UWF OCTA to refine DR staging and influence clinical decision-making, supporting its complementary role alongside fundus photography in specialised diabetic eye care.
SN  - 1471-2415
ER  -