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The rigorously standardized and validated grading system for diabetic retinopathy (DR) severity as outlined in the Early Treatment Diabetic Retinopathy Study (ETDRS) in 19911 has allowed clinicians and researchers to compare diabetic retinal disease outcomes across diverse cohorts and to predict risks of retinopathy progression over time. Seminal studies defining current best practices for the evaluation and management of DR and diabetic macular edema have used this ETDRS protocol. However, due primarily to imaging limitations of the era in which it was developed, the ETDRS system only evaluates about 30% of the total retina area. Technological advances now allow us to image more than 80% of the retina with a single 200° field captured in a quarter-second. This new capability raises the important question of whether evaluation of retinal findings in areas outside the standard ETDRS fields may substantially impact patient management.
Sun JK, Aiello LP. The Future of Ultrawide Field Imaging for Diabetic RetinopathyPondering the Retinal Periphery. JAMA Ophthalmol. 2016;134(3):247-248. doi:10.1001/jamaophthalmol.2015.5384