{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T02:00:28Z","timestamp":1775872828311,"version":"3.50.1"},"reference-count":158,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Abu Dhabi\u2019s Advanced Technology Research Council via the ASPIRE Award for Research Excellence Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Diabetic retinopathy (DR) is a devastating condition caused by progressive changes in the retinal microvasculature. It is a leading cause of retinal blindness in people with diabetes. Long periods of uncontrolled blood sugar levels result in endothelial damage, leading to macular edema, altered retinal permeability, retinal ischemia, and neovascularization. In order to facilitate rapid screening and diagnosing, as well as grading of DR, different retinal modalities are utilized. Typically, a computer-aided diagnostic system (CAD) uses retinal images to aid the ophthalmologists in the diagnosis process. These CAD systems use a combination of machine learning (ML) models (e.g., deep learning (DL) approaches) to speed up the diagnosis and grading of DR. In this way, this survey provides a comprehensive overview of different imaging modalities used with ML\/DL approaches in the DR diagnosis process. The four imaging modalities that we focused on are fluorescein angiography, fundus photographs, optical coherence tomography (OCT), and OCT angiography (OCTA). In addition, we discuss limitations of the literature that utilizes such modalities for DR diagnosis. In addition, we introduce research gaps and provide suggested solutions for the researchers to resolve. Lastly, we provide a thorough discussion about the challenges and future directions of the current state-of-the-art DL\/ML approaches. We also elaborate on how integrating different imaging modalities with the clinical information and demographic data will lead to promising results for the scientists when diagnosing and grading DR. As a result of this article\u2019s comparative analysis and discussion, it remains necessary to use DL methods over existing ML models to detect DR in multiple modalities.<\/jats:p>","DOI":"10.3390\/s22093490","type":"journal-article","created":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T08:21:25Z","timestamp":1651652485000},"page":"3490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["The Role of Different Retinal Imaging Modalities in Predicting Progression of Diabetic Retinopathy: A Survey"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-9709","authenticated-orcid":false,"given":"Mohamed","family":"Elsharkawy","sequence":"first","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8842-418X","authenticated-orcid":false,"given":"Mostafa","family":"Elrazzaz","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6838-8211","authenticated-orcid":false,"given":"Ahmed","family":"Sharafeldeen","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8190-5263","authenticated-orcid":false,"given":"Marah","family":"Alhalabi","sequence":"additional","affiliation":[{"name":"Electrical, Computer and Biomedical Engineering Department, College of Engineering, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3318-2851","authenticated-orcid":false,"given":"Fahmi","family":"Khalifa","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1931-3416","authenticated-orcid":false,"given":"Ahmed","family":"Soliman","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6084-3622","authenticated-orcid":false,"given":"Ahmed","family":"Elnakib","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2557-9699","authenticated-orcid":false,"given":"Ali","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9045-6698","authenticated-orcid":false,"given":"Mohammed","family":"Ghazal","sequence":"additional","affiliation":[{"name":"Electrical, Computer and Biomedical Engineering Department, College of Engineering, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates"}]},{"given":"Eman","family":"El-Daydamony","sequence":"additional","affiliation":[{"name":"Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt"}]},{"given":"Ahmed","family":"Atwan","sequence":"additional","affiliation":[{"name":"Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt"}]},{"given":"Harpal Singh","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-1323","authenticated-orcid":false,"given":"Ayman","family":"El-Baz","sequence":"additional","affiliation":[{"name":"Bioengineering Department, University of Louisville, Louisville, KY 40292, USA"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e93751","DOI":"10.1172\/jci.insight.93751","article-title":"Diabetic retinopathy: Current understanding, mechanisms, and treatment strategies","volume":"2","author":"Duh","year":"2017","journal-title":"JCI Insight"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.tem.2017.05.005","article-title":"A unified pathophysiological construct of diabetes and its complications","volume":"28","author":"Schwartz","year":"2017","journal-title":"Trends Endocrinol. 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