{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:41:05Z","timestamp":1760031665595,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Eye Institute","award":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"],"award-info":[{"award-number":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"]}]},{"DOI":"10.13039\/100002089","name":"Sight International Retinal Research Foundation","doi-asserted-by":"publisher","award":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"],"award-info":[{"award-number":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"]}],"id":[{"id":"10.13039\/100002089","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Alcon Research Institute Young Investigator Grant","award":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"],"award-info":[{"award-number":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"]}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"],"award-info":[{"award-number":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research to Prevent Blindness","award":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"],"award-info":[{"award-number":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"]}]},{"name":"Taubman Medical Research Institute and the JDRF Center of Excellence","award":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"],"award-info":[{"award-number":["1K08EY027458","1R01EY033000","1R01EY034325","FFSGIA16002","P30 EY007003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Fluorescein angiography (FA) is essential for diagnosing and managing diabetic retinopathy (DR) and other retinal vascular diseases and has recently demonstrated potential as a quantitative tool for disease staging. The advent of ultra-widefield (UWF) FA, allowing visualization of the peripheral retina, enhances this potential. Retinal hypoperfusion is a critical risk factor for proliferative DR, yet quantifying it reliably remains a challenge. Methods: This study evaluates the efficacy of the Michigan grid method, a software-based grading system, in detecting retinal hypoperfusion compared to the traditional freehand method. Retinal UWF fluorescein angiograms were obtained from 50 patients, including 10 with healthy retinae and 40 with non-proliferative DR. Two independent, masked graders quantified hypoperfusion in each image using two methods: freehand annotation and a new Michigan grid method. Results: Using the Michigan grid method, Grader 1 identified more ungradable segments, while Grader 2 identified more perfused and nonperfused segments. Cohen\u2019s weighted kappa indicated substantial agreement, which was slightly higher for the entire retina (0.711) compared to the central retinal area (0.686). The Michigan grid method shows comparable or slightly improved inter-rater reliability compared to the freehand method. Conclusions: This study demonstrates a new Michigan grid method for the evaluation of FA for hypoperfusion while highlighting ongoing challenges in achieving consistent and objective retinal nonperfusion assessment, underscoring the need for further refinement and the potential integration of automated approaches.<\/jats:p>","DOI":"10.3390\/diagnostics15070875","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T04:21:01Z","timestamp":1743481261000},"page":"875","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Grid-Based Software for Quantification of Diabetic Retinal Nonperfusion on Ultra-Widefield Fluorescein Angiography"],"prefix":"10.3390","volume":"15","author":[{"given":"Amro","family":"Omari","sequence":"first","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlyn","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric B.","family":"Desjarlais","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8414-1559","authenticated-orcid":false,"given":"Maverick","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Fernanda","family":"Abalem","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris A.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Joltikov","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rida M.","family":"Khan","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5653-5109","authenticated-orcid":false,"given":"Andrew","family":"DeOrio","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas W.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0615-628X","authenticated-orcid":false,"given":"Yannis M.","family":"Paulus","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"},{"name":"Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA"},{"name":"Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Thiran","family":"Jayasundera","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Early Treatment Diabetic Retinopathy Study Research Group (1991). Fluorescein Angiographic Risk Factors for Progression of Diabetic Retinopathy ETDRS Report Number 13. 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