Impact of Ultra-widefield Imaging on Understanding the Pathophysiology of Peripheral Retinal Degeneration

Abstract

Ultra-widefield imaging has revolutionized the understanding of the retinal periphery in clinical practice. Since the publication of the study “Comparison of image-assisted versus traditional fundus examination,” the practice of using fundus imaging to guide retinal examination has become ubiquitous, not only by experienced doctors in practice, but in the training of new clinicians.1 Quick capture and review of micron-level views with various wavelengths allows clinicians to plan their fundus exam, focus their time on areas of suspicion and better understand the health of the entire retina more effectively and efficiently. Image-assisted ophthalmoscopy has excellent agreement for a variety of lesion types but confers an advantage in optic nerve assessment, review of small lesions in the mid and far periphery and in visualization of vitreous lesions. Increasing resolution, integration of new wavelengths, auto-montage, optical coherence tomography and artificial intelligence have improved the sensitivity of this tool - thus improving the overall efficiency of a fundus exam, improving outcomes and leading to more accurate assessment of risk. Advances in ultra-widefield imaging technology have allowed us to better understand the anatomy and physiology of the peripheral retina and its relation to sight threatening disease; making this an invaluable tool to educate our students in training as well as our patients with and without retinal pathology in the clinic. When an image or lesion of concern can be viewed simultaneously by student and instructor or by doctor and patient, the learning and understanding from this ultra-widefield perspective are invaluable. In this review, we explore the technological advances and the impact on detection, diagnosis and prognostic potential in a variety of retinal degenerations. In addition, we examine remaining challenges of the technology.