Diabetic Retinopathy Classification: ETDRS 7-fields vs Widefield Imaging (ClarusDR)

NCT05746975 | Completed

• 1 other identifier: 4C-2023-12
• Study Type: observational
• Target: 81
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this observational study is to analyse and compare Diabetic Retinopathy severity level using 30º ETDRS 7-fields and Wide-field Imaging techniques using Clarus 500 (Carl Zeiss Meditech Inc., Dublin, USA) and Optos (Optos, Dunfermline, UK) in diabetic patients with mild to moderate diabetic retinopathy. The main questions it aims to answer are: 1\. To compare the Clarus 500TM wide-field imaging technique with the ETDRS 7-fields method in the assessment of DR severity level using the ETDRS DRSS.2. To compare the two wide-field imaging techniques (Clarus 500TM vs OptosTM) in the assessment of DR severity level using the ETDRS DRSS.3. To evaluate the peripheral area imaged by the wide-field Clarus 500TM and OptosTM to characterize DR lesions distribution (predominantly observed within or outside the ETDRS 7-fields) and severity (according to the ETDRS standard photos).4. To determine the relevance and frequency of DR PPL, located outside the ETDRS 7-fields area, and to explore PPL occurrence in different DR severity levels. Participants will undergo a non-invasive ophthalmological examination, which includes BCVA, 7-fields CFP and UWF FP to assess ETDRS DRSS level.

Conditions

Retinopathy, Diabetic

Outcome Measures

Primary Outcomes (3)

• ETDRS severity level according to the Early Treatment Diabetic Retinopathy Study - Diabetic Retinopathy Severity Scale (ETDRS-DRSS).

  Compare DR severity level between the ETDRS 7-fields imaging and the wide-field imaging techniques: Clarus 500TM and OptosTM. The ETDRS - DRSS goes from level 10 - no presence of DR to level 75 - Severe proliferative DR

  12 months

• One or more than 2-steps change on ETDRS - DRSS severity level

  Compare ETDRS -DRSS between the two imaging techniques and evaluate the presence of 1 step or more than 2 steps difference between ETDRS 7-fields imaging and the wide-field imaging techniques: Clarus 500TM and OptosTM

  12 months

• Peripheral DR lesions characterization

  Investigate the peripheral area and analyze the presence, distribution, and severity of peripheral DR lesions, in wide-field images: Clarus 500TM and OptosTM. Presence and distribution of lesions in the periphery will be evaluated as 1) Not observed; 2) predominantly observed outside ETDRS fields; 3) Uniformly distributed within and outside ETDRS fields. 4) Ungradable. Severity of the peripheral lesions will be evaluated using the same ETDRS-DRSS scale described above and will vary between level 35 and level 65. Also, it will then be compared with the ETDRS 7-field area and graded as less, equivalent or greater than the observed inside ETDRS 7-fields area.

  12 months

Secondary Outcomes (3)

• Evaluation of Images quality in each imaging modality.

  12 months

• Evaluation of Patients satisfaction about each imagining modality.

  12 months

• Correlate and analysed DR findings in each imaging technique with disease severity

  12 months

Eligibility Criteria

• Age: 35 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Diabetic type 2 patients with mild to moderate/severe NPDR

You may qualify if:

• DM type 2 according to 1985 World Health Organization (WHO) criteria
• Age between 35 and 80 years
• BCVA ≥ 75 letters (20 /32)
• Refraction with a spherical equivalent less than 5 Diopters
• NPDR levels 35 and 43-47 (based on the ETDRS criteria - 7 fields CFP)

You may not qualify if:

• Cataract or other eye disease that may interfere with fundus examinations
• Glaucoma
• Other retinal vascular disease than DR
• Refractive errors \> to + or - 5 Diopters
• Pupil diameter of less than 5 mm
• Poor quality images due to artifacts, movements, or media opacities

Sponsors & Collaborators

• Association for Innovation and Biomedical Research on Light and Image: lead

Study Sites (1)

AIBILI-CEC (AIBILI- Clinical Trials Centre)

Coimbra, 3000-548, Portugal

Location

Related Publications (16)

• Shimizu K, Kobayashi Y, Muraoka K. Midperipheral fundus involvement in diabetic retinopathy. Ophthalmology. 1981 Jul;88(7):601-12. doi: 10.1016/s0161-6420(81)34983-5.

  PMID: 6167923 BACKGROUND

• Wessel MM, Aaker GD, Parlitsis G, Cho M, D'Amico DJ, Kiss S. Ultra-wide-field angiography improves the detection and classification of diabetic retinopathy. Retina. 2012 Apr;32(4):785-91. doi: 10.1097/IAE.0b013e3182278b64.

  PMID: 22080911 BACKGROUND

• Silva PS, Cavallerano JD, Haddad NM, Kwak H, Dyer KH, Omar AF, Shikari H, Aiello LM, Sun JK, Aiello LP. Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years. Ophthalmology. 2015 May;122(5):949-56. doi: 10.1016/j.ophtha.2015.01.008. Epub 2015 Feb 19.

  PMID: 25704318 BACKGROUND

• Silva PS, Cavallerano JD, Sun JK, Soliman AZ, Aiello LM, Aiello LP. Peripheral lesions identified by mydriatic ultrawide field imaging: distribution and potential impact on diabetic retinopathy severity. Ophthalmology. 2013 Dec;120(12):2587-2595. doi: 10.1016/j.ophtha.2013.05.004. Epub 2013 Jun 15.

  PMID: 23778092 BACKGROUND

• Chen A, Dang S, Chung MM, Ramchandran RS, Bessette AP, DiLoreto DA, Kleinman DM, Sridhar J, Wykoff CC, Kuriyan AE. Quantitative Comparison of Fundus Images by 2 Ultra-Widefield Fundus Cameras. Ophthalmol Retina. 2021 May;5(5):450-457. doi: 10.1016/j.oret.2020.08.017. Epub 2020 Aug 29.

  PMID: 32866664 BACKGROUND

• Rasmussen ML, Broe R, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Comparison between Early Treatment Diabetic Retinopathy Study 7-field retinal photos and non-mydriatic, mydriatic and mydriatic steered widefield scanning laser ophthalmoscopy for assessment of diabetic retinopathy. J Diabetes Complications. 2015 Jan-Feb;29(1):99-104. doi: 10.1016/j.jdiacomp.2014.08.009. Epub 2014 Aug 28.

  PMID: 25240716 BACKGROUND

• Silva PS, Cavallerano JD, Sun JK, Noble J, Aiello LM, Aiello LP. Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy. Am J Ophthalmol. 2012 Sep;154(3):549-559.e2. doi: 10.1016/j.ajo.2012.03.019. Epub 2012 May 23.

  PMID: 22626617 BACKGROUND

• Wessel MM, Nair N, Aaker GD, Ehrlich JR, D'Amico DJ, Kiss S. Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular oedema. Br J Ophthalmol. 2012 May;96(5):694-8. doi: 10.1136/bjophthalmol-2011-300774. Epub 2012 Mar 15.

  PMID: 22423055 BACKGROUND

• Price LD, Au S, Chong NV. Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with diabetic retinopathy. Clin Ophthalmol. 2015 Mar 24;9:527-31. doi: 10.2147/OPTH.S79448. eCollection 2015.

  PMID: 25848202 BACKGROUND

• Matsui Y, Ichio A, Sugawara A, Uchiyama E, Suimon H, Matsubara H, Sugimoto M, Ikesugi K, Kondo M. Comparisons of Effective Fields of Two Ultra-Widefield Ophthalmoscopes, Optos 200Tx and Clarus 500. Biomed Res Int. 2019 Dec 5;2019:7436293. doi: 10.1155/2019/7436293. eCollection 2019.

  PMID: 31886247 BACKGROUND

• Hirano T, Imai A, Kasamatsu H, Kakihara S, Toriyama Y, Murata T. Assessment of diabetic retinopathy using two ultra-wide-field fundus imaging systems, the Clarus(R) and Optos systems. BMC Ophthalmol. 2018 Dec 20;18(1):332. doi: 10.1186/s12886-018-1011-z.

  PMID: 30572870 BACKGROUND

• Aiello LP, Odia I, Glassman AR, Melia M, Jampol LM, Bressler NM, Kiss S, Silva PS, Wykoff CC, Sun JK; Diabetic Retinopathy Clinical Research Network. Comparison of Early Treatment Diabetic Retinopathy Study Standard 7-Field Imaging With Ultrawide-Field Imaging for Determining Severity of Diabetic Retinopathy. JAMA Ophthalmol. 2019 Jan 1;137(1):65-73. doi: 10.1001/jamaophthalmol.2018.4982.

  PMID: 30347105 BACKGROUND

• 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 May;98(5 Suppl):786-806.

  PMID: 2062513 BACKGROUND

• International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use.. ICH harmonized tripartite guideline: Guideline for Good Clinical Practice. J Postgrad Med. 2001 Jan-Mar;47(1):45-50. No abstract available.

  PMID: 11590294 BACKGROUND

• World Medical Association.. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373-4. Epub 2003 Jul 2. No abstract available.

  PMID: 11357217 BACKGROUND

• Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the Protection of Natural Persons with Regard to the Processing of Personal Data and on the Free Movement of Such Data. Off. J. Eur. Union 2016, L119, 1-88; DOI: L:2016:119:TOC.

  BACKGROUND

MeSH Terms

Conditions

Diabetic Retinopathy

Condition Hierarchy (Ancestors)

Retinal Diseases; Eye Diseases; Diabetic Angiopathies; Vascular Diseases; Cardiovascular Diseases; Diabetes Complications; Diabetes Mellitus; Endocrine System Diseases

Study Officials

• Ana R Santos, PhD

  Association for Innovation and Biomedical Research on Light and Image

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 6, 2023
• First Posted: February 28, 2023
• Study Start: April 3, 2023
• Primary Completion: November 4, 2024
• Study Completion: November 4, 2024
• Last Updated: November 27, 2024

Record last verified: 2024-11

Locations

PT (1)