Ease of ultra-widefield retinal imaging appeals to physicians, patients

April 15, 2016

Ultra-widefield retinal imaging is a user- and patient-friendly technique that is showing promise for improving clinical care.

Take-home message: Ultra-widefield retinal imaging is a user- and patient-friendly technique that is showing promise for improving clinical care. 

Reviewed by Wai-Ching Lam, MD

Toronto-Ultra-widefield retinal imaging enables a comprehensive assessment of retinal pathology, and studies evaluating this technology show that is helping to improve clinical diagnosis and management, said Wai-Ching Lam, MD.

“The ultra-widefield technology provides a high-resolution, nonstered image with up to a 200º field of view that represents 80% of the retina. In addition, the acquisition is non-contact, non-mydriatic, and is very fast, about 0.25 seconds, which makes the procedure very comfortable for patients,” Dr. Lam said. “Furthermore, the digital images are immediately available for review and stored electronically, which is convenient for serial follow-up and telehealth applications.”

The ultra-widefield imaging technology can be used to obtain color images, red-free images, fundus autofluorescence, fluorescein angiography, and indocyanine green (ICG) angiography.

Studies evaluating the images acquired compare favorably with those obtained using standard fundus photography, and because ultra-widefield imaging improves identification of pathology in the peripheral retina, the technique is helpful for imaging eyes with a variety of retinal diseases.

For example, research by Aiello et al. demonstrated the feasibility of ultra-widefield imaging for grading diabetic retinopathy severity. In addition, they also reported that the peripheral retinal lesions visualized using this technology can be a predictor of progression of diabetic retinopathy.

Investigators in another recent study reported that ultra-widefield color and autofluorescence imaging revealed age-related macular degeneration-like lesions in the peripheral retina in eyes without central macular disease, and others described its utility for examining eyes with various uveitic conditions.

Detecting sickle cell retinopathy

 

At the University of Toronto, Dr. Lam and colleagues have found the ultra-widefield imaging particularly useful to detect treatment-requiring sickle cell retinopathy. Patients with this hereditary disease usually undergo annual screening to detect the development of retinal changes. A study comparing findings of the ultra-widefield imaging with the gold standard of clinical examination found the new technology was at least as good as the office procedure for identifying pathology and offered some practical advantages, especially in young children or poorly cooperative patients.

“The ease of the ultra-widefield imaging is especially appreciated when screening for sickle cell retinopathy in children,” Dr. Lam said.

“The bright light used during the office procedure can be very bothersome to children, causing them to be uncooperative and therefore limiting our view,” he said. “The ultra-widefield imaging procedure uses scanning laser technology without any flash, and the scan can be finished without causing distress and before the child has a chance to blink.”

Dr. Lam and colleagues are also using the fluorescein angiography mode of the ultra-widefield imaging technology and are finding it is particularly useful when examining eyes with ocular retinoblastoma that may have multiple foci outside the posterior pole, and the fundus autofluorescence mode is proving helpful for examining children with congenital retinal diseases, Dr. Lam said.

 

Wai-Ching Lam, MD

E: dr.waiching.lam@gmail.com

 

This article was adapted from Dr. Lam’s presentation at the Ophthalmic Photographer Society Meeting during the 2015 meeting of the American Academy of Ophthalmology. Optos provides the camera used for studies conducted by Dr. Lam. He has no other relevant financial interest to disclose.