Automated quantitative characterisation of retinal vascular leakage and microaneurysms in ultra-widefield fluorescein angiography

Ultra-widefield fluorescein angiography (UWFA) is an emerging imaging modality used to characterise pathology in the retinal vasculature such as microaneurysms (MAs) and vascular leakage. Despite its potential value for diagnosis and disease surveillance, objective quantitative assessment of retinal pathology by UWFA is currently limited because it requires laborious manual segmentation by trained human graders. In this report, we describe a novel fully automated software platform, which segments MAs and leakage areas in native and dewarped UWFA images with retinal vascular disease. Comparison of the algorithm with human grader-generated gold standards demonstrated significant strong correlations for MA and leakage areas (intraclass correlation coefficient (ICC)=0.78–0.87 and ICC=0.70–0.86, respectively, p=2.1×10⁻⁷ to 3.5×10^–10 and p=7.8×10⁻⁶ to 1.3×10^–9, respectively). These results suggest the algorithm performs similarly to human graders in MA and leakage segmentation and may be of significant utility in clinical and research settings.