The body of research supporting the value of ultra-widefield (UWF) imaging is considerable and continuously growing. As a result, UWF is fast becoming the standard of care for retinal vascular disorders especially diabetic retinopathy.
The management of diabetic retinopathy (DR) presents a formidable and growing challenge to the ophthalmic community. According to the U.S. Centers for Disease Control (CDC), more than 30 million Americans (9.4% of the U.S. population) are diabetic,1 a number that is predicted to rise by 54% to 54.9 million by 2030.2 As a result, DR and other diabetic eye diseases are projected to follow a similar trend.3
DR is a silent disease that can manifest initially with few if any symptoms. While 40 to 45% of Americans diagnosed with diabetes are affected, only about half of these patients are aware they have diabetic eye disease.4 Consequently, many go untreated for far too long, losing vision and in some cases, going blind.
Thus, early detection particularly of those whose disease is most likely to progress, is critical for successful disease management.
In my experience, the addition of ultra-widefield (UWF) imaging to screening and evaluation protocols offers advantages that improve our ability to diagnose earlier and treat more effectively. In recent decades, the standard for evaluating DR disease severity has been Early Treatment Diabetic Retinopathy Study (ETDRS) photography.
Rishi P. Singh, MD
E: [email protected]
Dr. Singh is staff physician, Cole Eye Institute, Cleveland Clinic; medical director, Clinical Systems Office, Cleveland Clinic; and associate professor of ophthalmology, Case Western Reserve University. He is a consultant for Carl Zeiss Meditec and Optos.
1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017.
2. Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag. 2017;20(1):6-12.
3. National Eye Institute. Projections for Diabetic Retinopathy (2010-2030-2050). https://nei.nih.gov/ eyedata/diabetic#5. Accessed January 14, 2019.
4. National Eye Institute. Facts about Diabetic Eye Disease. https://nei.nih.gov/health/diabetic/ retinopathy. Accessed January 14, 2019.
5. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photography-an extension of the modified Airlie House classification: ETDRS report number 10. Ophthalmology. 1991;98(5)(suppl): 823-833.
6. 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; 32:785-791.
7. Silva PS, Cavallerano JD, Tolls D, Omar, A, Thakore K, Patel B, Sehizadeh M, Tolson AM, Sun JK, Aiello LP, Aiello PA. Potential Efficiency Benefits of Nonmydriatic Ultrawide Field Retinal Imaging in an Ocular Telehealth Diabetic Retinopathy Program. Diabetes Care. 2014;37(1):50-55.
8. 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 Retionpathy Severity. Ophthalmology. 2013;120(12):2587-2595.
9. Silva PS, Dela Cruz AJ, Ledesma MG, vanHemert J, Radwan A, Cavallerano JD, Aiello LM, Sun JK, Aiello, LP. Diabetic Retinopathy Severity and Peripheral Lesions Are Associated with Nonperfusion on Ultrawide Field Angiography. Ophthalmology. 2015;122(12):2465-72.
10. Silva PS, Elmasry M, Pisig A, Aldairy Y, Van Hemert J, Fleming A, Sun, JK, Aiello LP. Automated Hemorrhage and Microaneurysm Counts on Ultra-widefield Images Predict Increased Risk of Diabetic Retinopathy Progression Over 4 Years. Paper presented at The Association for Research in Vision and Ophthalmology X Annual conference; 2018 Apr 29- May 3; Honolulu, HI.
11. Choudhry, N. Classification & Guidelines for Wide Field Imaging: Recommendations from the International Wide Field Imaging Study Group. Poster session presented at: 51st Annual Retina Society Meeting; 2018 Sept 12-15; San Francisco, CA.
12. Aiello LP, Odia I, Glassman AR, Melia M, Jampol LM, Bressler NM, Kiss, S, Silva PS, Wykoff CC, Sun JK. Comparison of Early Treatment Diabetic Retinopathy Study Standard 7-Field Imaging With UltrawideField Imaging for Determining Severity of Diabetic Retinopathy. JAMA Ophthalmol. 2019; 137(1):65-73.
13. Silva PS, Horton MB, Clary D, Lewis DG, Sun JK, Cavallerano JD, Aiello LP. Identification of Diabetic Retinopathy and Ungradable Image Rate with Ultrawide Field Imaging in a National Teleophthalmology Program. Ophthalmology. 2016; 123(6):1360-7.
14. Silva PS, Cavallerano JD, Haddad NM, Trolls D, Thakore K, Patel B, Sehizadeh M, Tolson AM, Sun JK, Aiello LP. Comparison of Nondiabetic Retinal Findings Identified With Nonmydriatic Fundus Photography vs Ultrawide Field Imaging in an Ocular Telehealth Program. JAMA Ophthalmol. 2016; 134(3):330-4.
15. Adhi M, Silva FQ, Lang R, Seballos R, Sukol R, Feinleib S, Singh RP. Non-Mydriatic Ultra-Widefield Imaging Compared With Single-Field Imaging in the Evaluation of Peripheral Retinal Pathology. Ophthalmic Surg Lasers Imaging Retina. 2017;48(12):962-968.