Ophthalmic Photography Research Articles

Advancements in equine ophthalmic imaging enhance understanding of ocular and orbital anatomy and disease in standing sedated horses.

To review data on the advances in equine ophthalmic imaging that have been made during the past 5 years and highlight advantages of using multiple imaging modalities to improve clinical observational skills and improve diagnostic accuracy. A literature review from 2019 through 2024 of equine ophthalmic digital photography, fundus photography, ocular and orbital ultrasonography (US), ultrasound biomicroscopy (UBM), confocal microscopy (CM), spectral domain optical coherence tomography (SD-OCT), radiography, CT, and MRI. Digital photography remains the cornerstone of equine ophthalmic imaging for documenting examination findings, sharing information with colleagues, and consulting with specialists. Digital images also allow for in-depth postexamination review and evaluation, often revealing subtleties that may have otherwise gone undetected during the ophthalmic examination. Advanced imaging modalities are being used more frequently in equine ophthalmology, especially those that can be used with the horses standing under sedation, including US, UBM, SD-OCT, CM, and CT. Advances in equine ophthalmic imaging have led to many new clinical discoveries and to an increase in our knowledge of ocular anatomy and diseases in the horse. Many of these advanced diagnostic imaging modalities, such as MRI, CT, SD-OCT, and CM, are cost prohibitive and require substantial operator training to ensure proficiency. However, their availability in tertiary referral centers, such as veterinary teaching hospitals and large equine clinics/practices, is becoming more widespread. Advanced equine ophthalmic imaging data contributes substantially to our general understanding of clinical and applied anatomy and improves our understanding of the underlying pathogenesis associated with specific diseases.

Myopic Vascular Changes Revealed by Optical Tomography Angiography and Their Association with Myopic Fundus Manifestations

Introduction: We aimed to quantify and evaluate fundal vascular changes at different severities of myopia using optical tomography angiography (OCTA) and explore their association with fundus changes captured by ultra-widefield (UWF) fundus cameras. Methods: Seventy-four participants with myopia were enrolled in the study and underwent basic ophthalmic examination, OCTA, and UWF fundus photography. Multiple parameters were obtained using OCTA (flow area, structure thickness, and vessel density) and UWF fundus cameras (tessellation and parapapillary atrophy [PPA]). Results: The right eye of 30 participants with low and moderate myopia and 44 participants with high myopia (HM) were included. Patients with HM had a larger flow area of the outer retina (FA-OR) and a smaller thickness of choroid (TC). Axial length was significantly correlated with retinal and choroidal flow area and thickness in the different zones. The PPA area was positively correlated with FA-OR and negatively correlated with TC. Tessellation exhibited different levels of correlation with OCTA parameters regarding the flow area, thickness, and vessel density of the fundal layers, mainly in the inner retina. Conclusion: FA-OR and TC exhibited sensitive changes in patients with HM and axial elongation; therefore, they could serve as predictive OCTA biomarkers. The PPA and tessellation were connected to the vascular and structural changes revealed by OCTA.

Commentary: The tinsels and tassels of smartphone ophthalmic photography.

Commentary: The tinsels and tassels of smartphone ophthalmic photography.

Computer aided diabetic retinopathy detection based on ophthalmic photography: a systematic review and Meta-analysis.

To ensure the diagnostic value of computer aided techniques in diabetic retinopathy (DR) detection based on ophthalmic photography (OP). PubMed, EMBASE, Ei village, IEEE Xplore and Cochrane Library database were searched systematically for literatures about computer aided detection (CAD) in DR detection. The methodological quality of included studies was appraised by the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-DiSc was utilized and a random effects model was plotted to summarize data from those included studies. Summary receiver operating characteristic curves were selected to estimate the overall test performance. Subgroup analysis was used to identify the efficiency of CAD in detecting DR, exudates (EXs), microaneurysms (MAs) as well as hemorrhages (HMs), and neovascularizations (NVs). Publication bias was analyzed using STATA. Fourteen articles were finally included in this Meta-analysis after literature review. Pooled sensitivity and specificity were 90% (95%CI, 85%-94%) and 90% (95%CI, 80%-96%) respectively for CAD in DR detection. With regard to CAD in EXs detecting, pooled sensitivity, specificity were 89% (95%CI, 88%-90%) and 99% (95%CI, 99%-99%) respectively. In aspect of MAs and HMs detection, pooled sensitivity and specificity of CAD were 42% (95%CI, 41%-44%) and 93% (95%CI, 93%-93%) respectively. Besides, pooled sensitivity and specificity were 94% (95%CI, 89%-97%) and 87% (95%CI, 83%-90%) respectively for CAD in NVs detection. No potential publication bias was observed. CAD demonstrates overall high diagnostic accuracy for detecting DR and pathological lesions based on OP. Further prospective clinical trials are needed to prove such effect.

Multimodal imaging ocular sarcoidosis

The study objective was to present multimodal imaging of definite ocular sarcoidosis (OS) in a young adult. A 52-year old woman consulted for 5 days of photophobia, ocular pain on movement, and redness in her left eye. Slit-lamp examination showed bilateral inferior granulomatous keratic precipitates, high cellullarity in the anterior chamber, posterior synechiae and hypopigmented subretinal lesions in the inferior vascular arcade, and nasal retina. In addition to the complete ophthalmic examination fundus photography (FP), fluorescein angiography (FA) and optical coherence tomography-angiography (OCT-A) were performed.Multimodal imaging of both eyes of the patient was performed. FP showed periphlebitis, hypopigmented subretinal lesions in the inferior temporal vascular arcade, and nasal retina. FA showed late diffuse capillary leakage from the subretinal lesions and optic nerve. OCT-A showed decreased choroidal capillary density, small hypo-intense gray areas of retinal capillary hypoperfusion, and presence of confluent and isolated areas void of flow in the deep plexus and choriochapillaris. With these findings on the multimodal imaging, chest computed tomography scan, and negative laboratory workup for other diseases, a presumptive diagnosis of OS was made which was subsequently confirmed with a positive skin nodule biopsy. The combination of OCT-A and other diagnostic methods allows a more detailed evaluation of structural and functional clinical findings in OS. There are few studies on OCTA findings in OS. Further studies with larger samples are needed in order to establish specific OCTA findings that could be used as diagnostic criteria.

Keratoendotheliitis Fugax Hereditaria: A Novel Cryopyrin-Associated Periodic Syndrome Caused by a Mutation in the Nucleotide-Binding Domain, Leucine-Rich Repeat Family, Pyrin Domain-Containing 3 (NLRP3) Gene

To describe the phenotype and the genetic defect in keratoendotheliitis fugax hereditaria, an autosomal dominant keratitis that periodically affects the corneal endothelium and stroma, leading in some patients to opacities and decreased visual acuity. Cross-sectional, hospital-based study. Patient Population: Thirty affected and 7 unaffected subjects from 7 families, and 4 sporadic patients from Finland. Ophthalmic examination and photography, corneal topography, specular microscopy, and optical coherence tomography in 34 patients, whole exome sequencing in 10 patients, and Sanger sequencing in 34 patients. Clinical phenotype, disease-causing genetic variants. Unilateral attacks of keratoendotheliitis typically occurred 1-6 times a year (median, 2.5), starting at a median age of 11 years (range, 5-28 years), and lasted for 1-2days. The attacks were characterized by cornea pseudoguttata and haze in the posterior corneal stroma, sometimes with a mild anterior chamber reaction, and got milder and less frequent in middle age. Seventeen (50%) patients had bilateral stromal opacities. The disease was inherited as an autosomal dominant trait. A likely pathogenic variant c.61G>C in the NLRP3 gene, encoding cryopyrin, was detected in all 34 tested patients and segregated with the disease. This variant is present in both Finnish and non-Finnish European populations at a frequency of about 0.02% and 0.01%, respectively. Keratoendotheliitis fugax hereditaria is an autoinflammatory cryopyrin-associated periodic syndrome caused by a missense mutation c.61G>C in exon 1 of NLRP3 in Finnish patients. It is additionally expected to occur in other populations of European descent.

An introduction to OCT in retinal disease

Ocular coherence tomography (OCT) has been available to ophthalmologists for many years and has had a significant impact on the diagnosis and treatment of many eye conditions. This fast and non-invasive way to image the eye has had a considerable effect on ophthalmic photography services. OCT can be used to assess the structure of the cornea, iris, anterior chamber, optic nerve and retina. This article focuses upon its use in retinal conditions and explores how the technique is used to aid treatment and diagnosis.

Stereo imaging in ophthalmology: Part II

In Part I of this two-part series, the author looked at the history of stereo photography and its application and rationale to ophthalmology (Hancock R (2014) Stereo imaging in ophthalmology. International Journal of Ophthalmic Practice 5(2): 58–61). Part II will illustrate examples of stereo ophthalmic photography by means of anaglyphic images. To view the following images, you will require red and cyan anaglyph glasses.

Stereo imaging in ophthalmology

Stereo imaging in ophthalmology is an important diagnostic modality and a task not often undertaken in many ophthalmic photography departments. Origins of retinal stereo imaging date back to over 100 years ago. Stereo imaging is recommended, for example, for all photographs of the optic nerve head and for ocular angiography intended to determine clinically significant macular oedema. It is also useful in determining sub types of wet-form age-related macular degeneration. Stereo fundus photography and angiography facilitate the diagnostic process by clearly defining retinal structure and elevation. This allows the clinician to assess the patient's retina, presenting a 3D image that does not move and is not light sensitive. Stereo imaging of the fundus is useful for follow-up management of the patient, and is used extensively in clinical trials. This article will look at the history of stereo photography, its application and rationale to ophthalmology, and the different methods of attaining stereo images of the retina.

Familial Juvenile Normal-tension Glaucoma With Anterior Segment Dysgenesis

To describe a new familial syndrome consisting of anterior segment dysgenesis, glaucomatous optic neuropathy, and intraocular pressure (IOP) in the normal range. Observational case series. Subjects were available for examination from a 2-generation pedigree. Ophthalmic examination and photography, visual field examination, and optical coherence tomography of the peripapillary retinal nerve fiber layer were performed. In some subjects, medical work-up was performed. Eight affected subjects were identified. All had signs of Axenfeld-like anterior segment dysgenesis, ranging from a single fine iris process to diffuse broad iris synechiae extending to a prominent posterior embryotoxon. Four of the 8 subjects had glaucoma-appearing optic nerve heads with corresponding visual field defects; in a fifth subject, glaucoma was suspected on the basis of optic nerve appearance, but the visual field was full. IOP was consistently in the low-teens to mid-teens except in 1 eye in which it was 22 mm Hg, the highest recorded pressure in all examined subjects. A new phenotype is presented, characterized by IOP in the normal range, glaucomatous-appearing optic nerve cupping, and anterior segment dysgenesis. The suggested mode of inheritance is autosomal dominant with marked intrafamilial variability.

Physiological vitreous changes may contribute to the pathogenesis of macular degeneration

Editor, There is accumulating evidence that the vitreomacular interface, vitreomacular traction and mechanical stress might be risk factors for the development of age-related macular degeneration (AMD): vitreomacular adhesion may promote exudative AMD, total posterior vitreous detachment (PVD) as well as vitrectomy have been found to be protective against the development of AMD (Krebs et al. 2011; Schulze et al. 2012). The vitreous cortex touches the retinal surface, and developmental and age-related remodelling of the vitreous as well as the presence of a bursa premacularis has been described before (Worst & Los 1995). Los (1997) described in her PhD thesis that the human vitreous shows perimacular concentric circles of longitudinal cisterns as well as a bursa premacularis. Moreover, the perpendicular pillar-like cisterns undergo changes in time. More than 100 autopsy eyes, studied by Worst, were derived from patients above the age of 50 (mean age: 70); the findings of Los, described in her thesis, were based upon the examination of more than one hundred donor eyes from younger patients, with varying ages. All autopsy eyes were studied with courtesy of the Corneal Eye Bank in Amsterdam, and the anatomical studies were performed by the Jan Worst Research Group in Haren, the Netherlands. However, as it is technically very difficult to reveal and to photograph intact intravitreal structures in their three-dimensional organization after injection dye into fresh, unfixed vitreous bodies suspended in a balanced salt solution (BBS) – several specimens got damaged during preparation or were even lost!– it is impossible to give the exact number of eyes in which the typical perimacular elongated cistern-like structures and the bursa premacularis could be visualized (see Fig. 1A). With informed consent, clinical data were collected from ten patients above the age of 50 during triamcinolone-assisted vitrectomy in the Alkmaar Medical Center in Alkmaar, the Netherlands. The human vitreous shows in vivo identical perimacular concentric circles of longitudinal cisterns as well as a bursa premacularis (see Fig. 1B and C). Based upon these identical anatomical aspects of the vitreous and the location of perimacular and macular lesions in AMD, we hypothesize that there is a relationship: as such retinal and choroidal lesions geographically correspond with the location of the longitudinal vitreal cisterns and the bursa premacularis, they can be interpreted as mechanical effects that may progress to AMD, depending on the magnitude and direction of vector forces during eye rotations. The usual chronic course of AMD with exacerbations and remissions and often progressive, bilateral appearance are suggestive of intermittent traumatic effects. Physiological vitreous changes and eye rotations occur in everyone, but vitreous structures will only touch the retina in the presence of elongated cisterns and/or significant vitreous movements, which process might be facilitated by vitreomacular adhesions. Our hypothesis that mechanical stress might contribute to the pathogenesis of AMD is supported by the clinical findings of others, who used spectral domain optical coherence tomography to evaluate the vitreoretinal interface: a positive relationship between a persistent attachment of the posterior vitreous and early signs of AMD was found (Schulze et al. 2012) as well as a complete correspondence between the adhesion and subretinal neovascularization (Krebs et al. 2011). We realize that observational and anatomical, experimental studies have their limitations, and further histopathological as well as case–control studies are required to confirm our hypothesis. Bursa premacularis filled with ink in an autopsy eye (A) and clinically after injection of triamcinolone during pars plana vitrectomy (B and C). Area of Martegiani on the left of the bursa in the autopsy eye (A). The bursa premacularis in the center is surrounded by distended cisterns of the circulus petaliformis: these structures are thought to make contact with the retinal surface periodically. We thank Peter J. de Lint, vitreoretinal surgeon in the Medical Center Alkmaar; the Corneal Eye Bank, Amsterdam; the Jan Worst Research Group, Haren; the ophthalmic photography units of the VU University Medical Center, Amsterdam; and the Medical Center Alkmaar, the Netherlands.

Is more always better in cataract surgery?

magnitude and direction of vector forces during eye rotations. The usual chronic course of AMD with exacerbations and remissions and often progressive, bilateral appearance are suggestive of intermittent traumatic effects. Physiological vitreous changes and eye rotations occur in everyone, but vitreous structures will only touch the retina in the presence of elongated cisterns and ⁄or significant vitreous movements, which process might be facilitated by vitreomacular adhesions. Our hypothesis that mechanical stress might contribute to the pathogenesis of AMD is supported by the clinical findings of others, who used spectral domain optical coherence tomography to evaluate the vitreoretinal interface: a positive relationship between a persistent attachment of the posterior vitreous and early signs of AMD was found (Schulze et al. 2012) as well as a complete correspondence between the adhesion and subretinal neovascularization (Krebs et al. 2011). We realize that observational and anatomical, experimental studies have their limitations, and further histopathological as well as case–control studies are required to confirm our hypothesis. We thank Peter J. de Lint, vitreoretinal surgeon in the Medical Center Alkmaar; the Corneal Eye Bank, Amsterdam; the Jan Worst Research Group, Haren; the ophthalmic photography units of the VU University Medical Center, Amsterdam; and theMedical Center Alkmaar, the Netherlands.

Ocular angiography — a brief overview

Ophthalmic imaging is an integral part of any ophthalmic outpatient department or clinic. Providing diganostic support and valuable teaching resources — ophthalmic imaging is essential in monitoring many retinal pathologies. Recent advances in technology has revolutionized ophthalmic photography. This article provides a brief history and overview of ophthalmic imaging.

Tips in ophthalmic photography

Dear Editor, We congratulate Mahesh et al., for their article on “video indirect ophthalmoscopy using handheld video camera.”[1] Documentation of clinical findings is a crucial part of an ophthalmologist's work and is important for communication with col-leagues and patients. The quality of an image depends as much as on the photographer's knowledge of the anatomy and physiology of the eye, as it does on photographic techniques and technology. In this regard, we would like to describe certain techniques in anterior segment photography which would greatly enhance the quality of the images obtained using an inexpensive personal digital camera. The settings we recommend for external photography (for lids and adnexal structures) are: Most cameras have “auto focus” mode and the system automatically adjusts to select the best focus. For clinical photography it is better to switch off the auto focus mode and to select “central focus” mode. Flash is optional, depending on ambient lighting. It is better to capture he image with and without flash and choose the better one later. ISO settings should be set as “auto” unless the photographer is experienced with different ISO speeds of camera. An important setting is the “macro mode” function denoted by “flower symbol” [Fig. 1]. It allows the camera to focus on objects as close as 2-4 inches.[2] With this, finer details of lid and adnexal lesions like surface irregularity, vascularity, and pigmentation can be documented, preserving clarity even on zooming. With the same technique gross details of the anterior segment can also be photographed. Proper focus is obtained by pressing the shutter button halfway, then adjusting the camera to obtain clear focus as seen on the LCD viewfinder. On obtaining clear focus, the yellow-colored rectangle will change to green in the LCD viewfinder. Figure 1: Photograph showing “macro mode” in the cameraFor slit-lamp photography of the anterior segment, the digital camera should be placed in one of the slit-lamp oculars after adjusting focus. Cameras with 3 megapixel (MP) resolution cater to most of our needs in obtaining clinical photographs. Higher resolution cameras (>3 MP) are not required for this purpose. Choose cameras with the objective piece protruding out so that it can snugly fit into slit-lamp oculars. Settings recommended are centre focus, macro mode, flash off, auto ISO. Camera focus can be adjusted by depressing shutter halfway down until the green box appears. Yellow box indicates that the camera has to be repositioned to obtain better focus. Most anterior segment photographs require an external light source which is usually provided by ambient room lighting. Without an external light source, the camera makes poor choice regarding exposure, resulting in the image being too dark or too bright. However, for ocular findings like keratic precipitates, iris transillumination defects, or lens opacities, external light source is not necessary. Anterior segment photographs are obtained better with wide illumination with diffuser on. Good-quality photographs make scientific publications more convincing. They can also be used as evidence in medico-legal cases. Techniques of obtaining clinical photographs should be part of resident training. This method may help ophthalmologists working in resource-constraint situations to document ophthalmic findings without expensive photography equipments.

Smartphones in ophthalmology

The potential usefulness of smartphones in the medical field is evolving everyday. This article describes various tools available on smartphones, largely focusing on the iPhone, for the examination of an ophthalmic patient, for patient and physician education, as well as reference tools for both ophthalmologists and vision researchers. Furthermore, the present article discusses how smartphones can be used for ophthalmic photography and image management, and foremost, the usefulness of the applications such as the Eye Handbook for the ophthalmologist and interested students, patients, physicians, and researchers, currently available in the iPhone.

A Comparison of Argon Laser and Radiofrequency in Trichiasis Treatment

The aim of this study was to find concrete clinical evidence for determination of the best method of treatment for trichiasis and the location that responds best to treatment with radiofrequency and argon laser. This study was performed in 2007 and 2008 on 100 patients, involving a total of 1,181 lashes in contact with the globe. Patients were randomly assigned to 2 groups of treatment: the radiofrequency group (group 1; 2 watts, 2- to 3-mm depth, cut-coagulating mode) and the argon laser group (group 2; spot size 50 μm, 760 mW, 930-nm wavelengths, continuous). After complete ophthalmic examination and photography, the eyelid was divided into 3 segments (medial, central, and lateral) and treated. The patients were examined 3 months later in terms of response to treatment, pain, and complications. The mean age of the patients was 57.1 ± 24, ranging from 14 to 98 years. Of the 100 patients included, 56% were women and 44% were men. The results revealed the successful treatment of 472 (82.4%) lashes in the radiofrequency group and 383 (62.9%) in the argon laser group. Responses were significant in the central regions of the upper and lower lids (p = 0.001). Similarly, notching was observed in 4 cases, 3 of which (75%) belonged to the radiofrequency group. However, this trend was not statistically significant. The radiofrequency method was found to be superior in comparison to argon laser in the central regions of both upper and lower eyelids.

Bilateral Episcleritis as a Manifestation of Cutaneous Leukocytoclastic Vasculitis

Purpose: The authors describe how bilateral episcleritis can be a sign of active systemic disease and can respond to treatment in a patient with cutaneous leukocytoclastic vasculitis. Design: Case report. Methods: Comprehensive ophthalmic and physical examination and color photography were used to monitor inflammation and its response to systemic immunosuppression. Results: Systemic cyclophosphamide caused regression of systemic symptoms, cutaneous lesions, and episcleritis. After an 8-month follow-up, the patient has not had a systemic or ocular recurrence. Conclusion: Episcleritis may be a manifestation of cutaneous leukocytoclastic vasculitis. Careful examination of ocular inflammation is important in monitoring systemic disease and treatment.

Étude des rapports papille-fovéa par rétinophotographie chez le patient sain

The measurement of ocular torsion remains complicated and delicate when using subjective methods of measurement. Objective measures are now accessible in daily practice. This study determined the standards for ocular torsion in healthy patients with fundus photographs. Prospective study on 150 patients divided into three different age groups: children (under 15 years); young adults (15-50 years); and adults (over 50 years). All patients included had a normal oculomotor examination and were close to emmetropia. The fundus photographs were taken using a standardized system. The results were analyzed with a graphic computer program and took into consideration reproducible anatomical models; a statistical study determined the thresholds of statistical significance. The optic nerve head-fovea angle followed a Gaussian distribution (mean, 6.3; standard deviation, 3.4). The measure was reproducible in a single patient through different successive examinations. There was no variation of this angle between the patients of different ages. Furthermore, in 87% of the patients, the fovea had a projection between the center and the lower edge of the optic nerve head, indicating that these anatomical models are reliable in a clinical evaluation of torsion. This study confirms the accuracy of the objective measurements of ocular torsion and validates the anatomical models proposed by the rare studies already published. The era of systematic ophthalmic photography is opening new perspectives in diagnosis now that the range in healthy patients has been determined, necessary before the disease could be analyzed. This validation of reliable and simple anatomical models should make this method easy to use in clinical and daily practice.

THE COMS RANDOMIZED TRIAL OF IODINE 125 BRACHYTHERAPY FOR CHOROIDAL MELANOMA

Objective: To describe the frequency and predictors of local treatment failure and enucleation after iodine 125 (I) brachytherapy in patients with choroidal melanoma treated and followed up in a large randomized clinical trial. Design: Prospective, noncomparative, interventional case series within a randomized, multicenter clinical trial. Participants: Patients enrolled in the Collaborative Ocular Melanoma Study (COMS) trial of enucleation versus brachytherapy between February 1987 and July 1998; tumors measured 2.5 to 10.0 mm in apical height and no more than 16.0 mm in longest basal dimension. Methods: I brachytherapy was administered via episcleral plaque according to a standard protocol. Follow-up ophthalmic evaluations, including ophthalmic ultrasound and fundus photography, were performed according to a standard protocol at baseline, every 6 months thereafter for 5 years, and subsequently at annual intervals. Survival analysis methods were used to estimate the cumulative risk of postirradiation treatment failure and enucleation. Factors associated with treatment failure and enucleation of plaqued eyes were evaluated using Cox proportional hazards analysis. Main Outcome Measures: Reports of enucleation and of local treatment failure, defined as tumor growth, recurrence, or extrascleral extension, derived from clinical reports based on echographic and photographic documentation. Results: As of September 30, 2000, 638 of the 650 patients randomized to brachytherapy and so treated had been followed up for 1 year or longer, and 411 had been followed up for at least 5 years. Sixty-nine eyes were enucleated during the first 5 years after brachytherapy, and treatment failure was reported for 57 eyes. The Kaplan-Meier estimate of proportion of patients undergoing enucleation by 5 years was 12.5% (95% confidence interval [CI], 10.0%–15.6%); the risk of treatment failure was 10.3% (95% CI, 8.0%–13.2%). Treatment failure was the most common reason for enucleation within 3 years of treatment; beyond 3 years, ocular pain was most common. Risk factors for enucleation were greater tumor thickness, closer proximity of the posterior tumor border to the foveal avascular zone, and poorer baseline visual acuity in the affected eye. Risk factors for treatment failure were older age, greater tumor thickness, and proximity of the tumor to the foveal avascular zone. Local treatment failure was associated weakly with reduced survival after controlling for baseline tumor and personal characteristics (adjusted risk ratio, 1.5; P 0.08). Conclusions: Local treatment failure and enucleation were relatively infrequent events after I brachytherapy within the COMS. Treatment failure typically occurred early and was associated weakly with poorer survival. The COMS randomized trial documented the absence of a clinically or statistically significant difference in survival for patients randomly assigned to enucleation versus brachytherapy. This analysis documents the efficacy of brachytherapy to achieve sustained local tumor control and to conserve the globe. Ophthalmology 2002;109:2197–2206 © 2002 by the American Academy of Ophthalmology.

Ophthalmic Photography: Retinal Photography, Angiography, and Electronic Imaging, 2nd ed

Ophthalmic Photography: Retinal Photography, Angiography, and Electronic Imaging, 2nd ed