Peripheral Retinal Degeneration Research Articles

Primary visual cortical remapping in patients with inherited peripheral retinal degeneration.

Human studies addressing the long-term effects of peripheral retinal degeneration on visual cortical function and structure are scarce. Here we investigated this question in patients with Retinitis Pigmentosa (RP), a genetic condition leading to peripheral visual degeneration. We acquired functional and anatomical magnetic resonance data from thirteen patients with different levels of visual loss and twenty-two healthy participants to study primary (V1) visual cortical retinotopic remapping and cortical thickness. We identified systematic visual field remapping in the absence of structural changes in the primary visual cortex of RP patients. Remapping consisted in a retinotopic eccentricity shift of central retinal inputs to more peripheral locations in V1. Importantly, this was associated with changes in visual experience, as assessed by the extent of the visual loss, with more constricted visual fields resulting in larger remapping. This pattern of remapping is consistent with expansion or shifting of neuronal receptive fields into the cortical regions with reduced retinal input. These data provide evidence for functional changes in V1 that are dependent on the magnitude of peripheral visual loss in RP, which may be explained by rapid cortical adaptation mechanisms or long-term cortical reorganization. This study highlights the importance of analyzing the retinal determinants of brain functional and structural alterations for future visual restoration approaches.

Ultra-Widefield Imaging in Patients with Angioid Streaks Secondary to Pseudoxanthoma Elasticum

To investigate the application of noninvasive ultra-widefield (UWF) imaging in patients with angioid streaks secondary to pseudoxanthoma elasticum (PXE) and to compare detected findings with those obtainable with 7 standard 30° fields (7SF) imaging. Cross-sectional, observational study. Forty eyes of 20 consecutive patients with angioid streaks secondary to PXE (8 women and 12men; mean age, 56.9 ± 12.3 years). Consecutive patients with angioid streaks secondary to PXE seeking treatment between January and June 2016 at the Medical Retina & Imaging Unit of the Department of Ophthalmology, University Vita-Salute San Raffaele, underwent UWF imaging (California; Optos PLC, Dunfermline, UK). Ultra-widefield color images andfundus autofluorescence (FAF) were evaluated. Ultra-widefield findings then were compared with those obtainable with 7SF. Types and location of retinal lesions secondary to PXE. Peripheral lesions not entirely visible with 7SF were identified in 29 of 40 eyes (72.5%; P < 0.0001). These peripheral lesions included peau d'orange (52.5% of the eyes), coquille d'oeuf (52.5%), cracked eggshell (5.0%), comet lesions (27.5%), peripheral retinal degenerations (17.5%), parastreak atrophies (10.0%), and peripheral hemorrhage (5.0%). Furthermore, chorioretinal atrophies, drusen of the optic disc, cracked eggshell, pattern-like dystrophies, and retinal hemorrhages associated with angioid streaks were observed on digital color or FAF images, or both, and described. Ultra-widefield imaging showed valuable usefulness in patients with angioid streaks by providing in a single image the entire spectrum of retinal alterations associated with PXE. Peripheral lesions oftenare present in patients with angioid streaks and may be missed with 7SF imaging. A careful examinationoffundus periphery should be performed during screening and follow-up visits.

Secondary diseases in high myopia

Eyes with high myopia (axial length≥ 26.5mm) do not just have adifferent size. Due to morphological and structural changes there is aconsiderably increased risk for many different secondary diseases. Determination of the incidence and mortality in high myopia, discussion of effects and clinical signs, presentation of treatment recommendations and counselling. A systematic search of the literature was carried out and a discussion on basic principles and epidemiological investigations is presented. Findings due to high myopia are not in aclosed state but undergo continuous changes. Choroidal neovascularization (adjusted prevalence 2.5-5%), staphyloma, foveoschisis and peripheral retinal degeneration are examples of problems contributing to the increased rate of visual impairment and blindness related to myopia. High myopia is associated with aclearly increased risk of retinal detachment after lens surgery (hazard ratio 6.1) and particularly more frequently in younger people. The associated primary open-angle glaucoma (odds ratio 2.46) is often recognized too late due to relatively low values of intraocular pressure. Understanding of atrophic areas and staphyloma has benefited from recent advances in imaging (e.g. magnetic resonance imaging, optical coherence tomography and wide-field imaging) that complement and explain histological findings. Knowledge of the associated risk profile is of major clinical relevance.

A comparison of peripheral retinal degeneration areas in high myopia retinal detachment patients with or without diabetes

Objective To compare the occurrence of peripheral retinal degeneration in high myopic (higher than -6.00 D) retinal detachment patients without diabetes and that with diabetes. Methods Two hundred and eleven eyes of 211 cases of high myopia with retinal detachment were divided into two groups. Group A included 156 eyes of 156 cases of high myopia with retinal detachment but without diabetes. Group B included 55 eyes of 55 cases of high myopia with retinal detachment and with diabetes. The peripheral retina was checked with three-mirror contact lens, especially being examined during vitrectomy surgery. The status of peripheral retinal degeneration were recorded. Results In group A, there were 121 eyes with obvious peripheral retinal degeneration, accounting for 77.56%. In group B, there were 21 eyes with obvious peripheral retinal degeneration, accounting for 38.18%. The difference of incidence of peripheral retinal degeneration between the two groups was statistically significant (χ2=28.66, P=0.000). Conclusion The incidence of peripheral retinal degeneration in patients of high myopia with retinal detachment and with diabetes was significantly lower than that in patients of high myopia with retinal detachment but without diabetes. Key words: Myopia, high; Retinal detachment; Degeneration, peripheral retina; Diabetes

Sclera as the target tissue in progressive myopia.

Introduction: The aim of the study was to study the eye corneoscleral shell and connective tissue (CT) system in children with acquired and congenital progressive myopia, and to identify the informative diagnostic criteria of weakened supporting function of the sclera. 155 children aged 9-17 were examined: 18 had emmetropia or hyperopia, 20--low, 32--moderate and 85--high myopia. 32 children had complicated myopia (CM) due to peripheral retinal degeneration (PRD). Corneal hysteresis (CH), scleral acoustic density (SAD), X-ray vertebral topography, plantography, joint hypermobility, serum cortisol (SC), and autonomic balance were measured. Corneal hysteresis, mmHg and SAD, rel. units (mean ± SE) were lower if myopia was higher: in low myopia, CH was 13.0 ± 0.3, in moderate myopia, 11.9 ± 0.3#, in high myopia, 10.7 ± 0.3#; SAD was resp. 215.9 ± 5.2, 204.9 ± 3.7# and 192.8 ± 5.8# (#: p < 0.05 with regard to low myopia). The lowest CH (10.3 ± 0.4) and SAD (186.5 ± 7.3) were found in acquired CM. Congenital myopia with PRD showed CH and SAD greater than in acquired CM (p < 0.05). Serum cortisol (nmol/L) in hyperopia was 335.8 ± 40.9 and dropped with higher myopia: in low myopia--290.7 ± 58.6, in moderate--250.9 ± 26.4, in high--243.9 ± 20.5. The lowest SC was found in acquired CM, consistent with CH and SAD. Connective tissue dysplasia progressed with higher myopia: it was found in 76.9% of children with low, 82.4% with moderate, 89.2% with high acquired myopia, and 91.7% with congenital myopia. Biomechanical defects of CT and hormonal imbalance were combined with vegetative nervous system (VNS) imbalance: in high myopia only 20.5% of children were eutonic, 61.5%--sympathicotonic and 17.5% parasympathicotonic. School age children with progressive myopia showed biomechanical abnormalities of the corneosclera, along with CT dysplasia, decreased SC and imbalanced VNS, more pronounced in acquired complicated myopia. Our findings contribute to the understanding of myopia pathogenesis and to the diagnostic/prognostic evaluation of myopic children, in particular when deciding whether sclera-strengthening intervention is needed.

A comparative study of the peripheral retinal degeneration between moderate and high myopia with retinal detachment

Objective To compare the occurrence of the peripheral retinal degeneration between moderate myopia and high myopia with retinal detachment. Methods One hundred and sixty-seven eyes of 166 myopic patients with retinal detachment who underwent vitrectomy were analyzed. These patients were divided into two groups according to myopic refractive degree: group A with 117 eyes of 117 cases of high myopia (-6.25D and over) with retinal detachment and group B with 50 eyes of 49 cases of moderate myopia (between -3.00D and -6.00D) with retinal detachment. The peripheral retinas of myopic patients were examined carefully through three-mirror contact lens and during the vitrectomy surgery. Results Twenty-nine eyes without peripheral retinal degeneration accounted for 24.79% and 88 eyes with obvious peripheral retinal degeneration accounted for 75.21% were in group A. One eye without peripheral retinal degeneration accounted for 2.00% and 49 eyes with obvious peripheral retinal degeneration accounted for 98.00% were in group B. The occurrence rates of peripheral retinal degeneration between the two groups were compared by using the chi-square test and the difference was statistically significant (χ2 =12.34, P=0.000). Conclusion The occurrence rate of peripheral retinal degeneration in high myopic patients with retinal detachment (group A) is obviously lower than that in moderate myopic patients with retinal detachment (group B). Key words: Myopia, moderate; Myopia, high; Retinal detachment; Degeneration, peripheral retina

PERIPHERAL RETINAL DEGENERATIONS AND RHEGMATOGENOUS DETACHMENT IN PRIMARY CONGENITAL GLAUCOMA

To determine the prevalence of peripheral retinal degenerations (PRD) and rhegmatogenous retinal detachment in patients with primary congenital glaucoma (PCG). Records of all patients with PCG operated from year 2000 onwards were evaluated to look for the prevalence of rhegmatogenous retinal detachment. Of these, those children who were old enough to cooperate and had sufficient medial clarity were screened with an indirect ophthalmoscopy in a cross-sectional evaluation from 2010 to 2014. Peripheral retina was examined, and prevalence of PRD was estimated in this subset. For statistical purposes, only one eye of each patient was considered in this cross-sectional analysis. Of the 310 eyes (180 patients with PCG) operated from the year 2000 onwards, a rhegmatogenous retinal detachment was noted in 13 eyes (4%). Mean axial length of these eyes was 26.3 ± 3.2 mm (range, 19.8-34.7 mm). Among the eyes screened for PRD (n = 60), prevalence of pathologic PRD (lattices with/without atrophic holes and isolated holes/tears) was 15%. The average follow-up between glaucoma filtering surgery and the date of last examination was 8.55 ± 3.98 years (range, 5-20 years) in this subset. Mean axial length was significantly greater in eyes with pathologic PRD than in those without (28.1 ± 3.3 mm vs. 25.8 ± 2.6 mm; P = 0.01). For axial length ≥ 26 mm, the odds of having a pathologic PRD were 14.4 times more than those with axial length < 26 mm (P < 0.001; 95% confidence interval, 1.7-120.5). Prevalence of PRD among eyes with PCG is high. Peripheral retinal screening should be performed in eyes with PCG, especially those with axial lengths ≥ 26 mm.

Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment.

Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of 57.7 ± 11.2 years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean = 3.14 ± 1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P = 0.002) and the presence of multiple tears (P = 0.01). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.

Cesarean section and eye disorders

Recently, a growing tendency for cesarean birth has been noted both, in Poland and worldwide. Non-obstetric problems constitute a large part of indications for cesarean section. Many ophthalmologists and obstetricians still believe that high myopia, the presence of peripheral retinal degenerations, history of retinal detachment surgery, diabetic retinopathy, or glaucoma are indications for surgical termination of pregnancy. However, these recommendations are not evidence-based. The literature offers no proof that high myopia and previous retinal surgery increase the risk of retinal detachment during spontaneous vaginal delivery. There is only one indication for cesarean section in myopic patients, i.e. the presence of choroidal neovascularization, which can cause subretinal bleeding with acute visual loss. Prolonged and intensified Valsalva maneuver during labor in patients with an active proliferative diabetic retinopathy may be an indication for an elective cesarean section. Uterine contractions during the second stage of vaginal delivery lead to a marked elevation of intraocular pressure. Intraocular pressure fluctuations during the delivery may damage retinal ganglion cells, resulting in further progression of visual field. Thus, glaucoma associated with advanced visual field changes is the next ophthalmic indication for cesarean section. The report presents the current state of knowledge concerning the effect of pregnancy on pre-existing ocular disorders and the influence of physiological changes on the clinical course of these diseases during the stages of natural delivery. The authors discuss also the ophthalmic indications for cesarean section.

Free-floating vitreous cyst

Free-floating intraocular cysts can be divided into those occurring in the anterior chamber, those occurring in the retrolental space, and those occurring in the vitreous cavity. The origin of vitreous cysts may be associated with remnants of the hyaloid system (congenital), or can result from trauma or ocular disease. The aim of this study was to assess the impact of free-floating vitreous cyst on the macula using optical coherence tomography, ultrasonography, and fluorescein angiography. A 58-year-old female patient presented for eye examination complaining of annoying movable floaters with glare and difficultly in close works. Ophthalmoscopic examination through the dilated fundus revealed posterior vitreous detachment, unremarkable peripheral retinal degenerations with no abnormalities at the optic disc, the macula or papillomacular bundle, and the anterior segment and pupillary reaction were free. This case report represents a case of free-floating vitreous cyst that has been advised for follow-up until it becomes visually significant, requiring interference either with argon laser cystotomy or aspiration through pars plana vitrectomy.

Clinical Analysis of Fundus Changes in Myopia

Objective: To assess the fundus changes and incidence of various peripheral retinal degeneration associated with Myopia and to correlate these changes with the age of the patients. Materials and Methods: Randomised Prospective observational study of 100 cases of myopia (less than or equal to -6D: 50 cases and more than -6D: 50 cases) all the patients detailed history was recorded and subjected to intensive examination of both Anterior segment and posterior segment of the eye. The various fundus features and pathological lesions in the different degrees of myopia were noted and analysed. Findings: Females were comparatively affected more. Majority of the patients did not have significant family history. Majority of the cases showed some fundus changes more common were tessellated fundus. Axial length is relatively increased in higher degrees of myopia. Peripheral retinal degeneration are more common in moderate to higher degrees of myopia. Applications: The degenerative changes of fundus is commonly seen in moderate to high degrees of myopia whereas in our study it is evident in lesser degree also. Hence thorough examination of peripheral fundus using indirect ophthalmoscope for all cases of myopia will help in early diagnosis and treatment.

Spectral‐domain EDI‐OCT in small uveal melanoma and “pseudomelanomas”

PurposeTo reveal diagnostic symptoms of small uveal melanoma and “pseudomelanomas” by spectral‐domain EDI‐OCT.MethodsThe results of complex research (ophthalmoscopy, ultrasonography, spectral‐domain EDI‐OCT) of 230 patients (230 eyes) aged from 13 to 75 (mean 49 ± 1.1) years with diagnosis “small uveal melanoma” were analyzed.ResultsIn 142 (61.7%) from 230 cases small uveal melanoma was diagnosed. The tomographycal symptoms were retinal thickness caused by neuroepithelium detachment, cystoid retinal edema; bow‐shaped choroidal profile; retinal thickness in contiguous zone caused by neuroepithelium detachment. In 88 cases (38.3%) “pseudomelanomas” were diagnosed. In age‐related macular degeneration (38) retinal pigment epithelium detachment, hyperreflective focus (subretinal membrane), equal choroidal profile; in subretinal hemorrhage (25) equal elevation of choroidal profile without retinal fluid; in peripheral retinal degeneration (12) retinal thinning, insignificant elevation of choroidal profile, hyperreflective foci on RPE level; in congenital hypertrophy of retinal pigment epithelium (13) equal choroidal profile, retinal thinning, thickness of retinal pigment epithelium were diagnosed.ConclusionsThus, spectral‐domain EDI‐OCT allow to reveal small uveal melanoma and “pseudomelanomas” symptoms for adequate treatment.

Yüksek miyop hastalarda fakoemulsifikasyon ve intraokuler lens implantasyonun klinik sonuçları

Objective: To evaluate the clinical outcomes of phacoemulsification and intraocular lens (IOL) implantation in eyes with high myopia. Material and Methods: This retrospective study included 52 eyes of 35 patients with an axial length greater than 26 mm who had undergone phacoemulsification and IOL implantation surgery. Patients who had ocular pathologies other than high myopia and cataract were excluded from this study. All patients’ charts were reviewed, and preoperative and postoperative best corrected visual acuity (BCVA), refraction error values, and complications were recorded. Results: The mean age of the patients was 58.06±15.46 years (range 27 to 80 years), and the mean follow up time was 8.44±3.62 months. The mean preoperatively myopia was-10.94±4.75 diopters (D), mean axial length was 28.14±1.72 mm and the mean BCVA was 0.84±0.4 logMAR. Intraoperative vitreous loss occurred in two (3.85%) eyes, and a posterior chamber IOL was implanted in the sulcus in these cases. In 8 (15.4%) eyes, peripheral retinal degenerations detected and these patients underwent prophylactic argon laser treatment preoperatively. The mean postoperative spheric value was -0,26±1.51 D and, the mean BCVA was 0.24±0.24 logMAR. There was a significant decrease in the myopia values (Wilcoxon testi p

The effect of prophylactic laser barrage treatment before phacoemulsification in high myopia

Objective The aim of this work was to study the effect of prophylactic laser barrage treatment before phacoemulsification in high myopia. Background High myopia is considered as an important risk factor for the development of peripheral retinal degeneration and the subsequent development of retinal detachment, and hence, prophylactic laser barrage treatment is used for such uses. Patients and methods Thirty eyes of 20 patients with high myopia were divided into the following two groups: group I, high myopia with peripheral retinal degeneration subjected to laser retinopexy, and group II, high myopia with peripheral retinal degeneration not subjected to laser retinopexy. The two groups after undergoing phacoemulsification had been followed for the development of retinal detachment. Results Prophylactic laser barrage treatment significantly reduces the incidence of retinal detachment after phacoemulsification in high myopia. Conclusion Prophylactic laser barrage treatment decreases the incidence of retinal detachment after phacoemulsification in high myopia.

Ocular findings in patients with alopecia areata: role of ultra-wide-field retinal imaging.

Alopecia areata is understood as an autoimmune disease T cell-mediated mainly involving hair follicles in humans. It is a multifactorial aetiologic disease characterised by non-scarring alopecia and asymptomatic areas, affecting approximately 2 % of dermatology patients. Recent studies suggest that the pathogenesis of AA plays an important role in the association of certain HLA groups, neuroendocrine parameters and immunogenic factors. During 3 months (March to May 2013) at Hospital Clínic de Barcelona, 22 patients with severe alopecia areata underwent ophthalmic examination to determine whether there were ocular findings in the following parameters: Best-corrected visual acuity on decimal Snellen optotype, anterior segment slit-lamp examination and photograph, intraocular pressure measurement and dilated fundoscopy. Ultra-wide-field retinal imaging with or without red-free photograph was carried out with the Optomap 200 Tx (Optos, DunFermline, UK). Forty-four eyes of 22 patients were analysed [15 females (68.2 %)]. The mean age was 38.9 (SD 13.7) and mean time of evolution was 19.9 years (SD 16.3). Alopecia areata clinical patterns were multifocal [n = 10 (45.5 %)], universalis [n = 7 (31.8 %)], totalis [n = 3 (13.6 %)] and focal [n = 2 (9.1 %)]. Best-corrected visual acuity was 1.0 in almost all patients, but only three eyes (6.8 %) had vision of 0.7. Ocular findings were as follows: madarosis [n = 7 partial loss of eyelashes (31.85 %) and n = 4 total loss (18.2 %)], lens changes [n = 4 (18.2 %)], cataract [n = 3 (13.65 %)]. Ultra-wide fundus photography examination showed peripheral drusen [n = 17 eyes (38.6 %)], white-without-pressure changes [n = 8 eyes (18.22 %)] and peripheral retinal degenerations [n = 3 eyes (6.81 %)]. Ocular findings in patients with alopecia areata are reported and discussed by dermatologic and ophthalmic evaluation.

English

AIM: Study of peripheral retinal degeneration in relation to axial length of eyeball in myopic patient. METHOD: Study of 200 eyes of 100 patients who attended our hospital between 2010-2012.Detailed history was taken in every case. Inclusion criteria were patient with age group of 11years -70years, Patient with myopia. Exclusion criteria were patient with photopsia, history of trauma, diabetes hypertensive and undergone RD surgeries. Vision and refraction with Streak Retinoscopy was done. Axial length was recorded by A-scan biometry. Fundoscopy was done in all cases. RESULT: In our study number of males was 54 and females were 46. Peripheral chorioretinal lesions were noted to be associated with increased axial length of eye 1, 2 .Greater the antero-posterior ocular diameter the greater chance of peripheral chorioretinal degeneration 2 . CONCLUSION: Examination of periphery of retina is important in all myopic cases. Lattice degenerations are most common lesions1, 3. 60% of lesions are found in superotemporal quadrant. Tendency of bilaterality4 is noted in all degenerations except paving stone degeneration. Prevalence of lattice degeneration is maximum in axial length between 28-30mm 5 .

Argus II Retinal Prosthesis System for peripheral retinal degeneration

Argus II Retinal Prosthesis System for peripheral retinal degeneration

A Retrospective Clinical Study of the Etiology and Post-operative Visual Outcome of Rhegmatogenous Retinal Detachment.

To study the etiology of rhegmatogenous retinal detachment and visual outcome after retinal detachment surgery. Retrospective study conducted at the tertiary eye care hospital over a period of one year. Thirty eyes of 30 patients were included after fulfilling the inclusion criteria. Complete ocular examination details of each patient such as visual acuity for distant vision (checked with Snellen's acuity chart),slit lamp examination, fundus examination (done with +90D lens) and binocular indirect ophthalmoscopy. In addition the following were noted: extent of the detachment present, position and number of breaks, status of the macula, presence of PVR, mobility of retina and presence of any peripheral retinal degenerations, and fundus photographs of the patient (before and after surgery). Risk factors for retinal detachment included myopia in 7 eyes (23.3%), prior cataract surgery in 10 eyes (33.3%), peripheral retinal degeneration in 3 eyes (10%) and traction with new vessels in 1 eye (3.3%). Eighteen eyes (60%) presented with macula off while 12 eyes (40%) presented with macula partly or completely attached. Visual acuity at presentation was <3/60 in 16 eyes. Following surgery, retina was attached in 28 eyes (93.3%) and remained detached in 2 eyes (6.7%). Visual acuity after surgery was <3/60 in 12 eyes.Visual acuity improved in 13 eyes (43.3%), remained the same in 16 eyes (53.3%) and worsened in 1 eye (3.3%). Myopia and prior cataract surgery are important risk factors for Rhegmatogenous Retinal Detachment. Majority of patients in this setting presented late with Rhegmatogenous Retinal Detachment and this was responsible for relatively poor visual outcomes despite good anatomical results after surgery. Proper screening of eyes at risk and education of patients is important for preventing visual loss due to retinal detachment.

Prevalence of Peripheral Retinal Degenerations in the Cases of Myopia- A Prospective Study

Prevalence of Peripheral Retinal Degenerations in the Cases of Myopia- A Prospective Study

Comparison of image-assisted versus traditional fundus examination.

The purpose of this study was to evaluate the ability of image-assisted fundus examination to detect retinal lesions compared with traditional fundus examination. Subjects were imaged using a nonmydriatic ultrawide field scanning laser ophthalmoscope. After imaging, subjects underwent both a traditional and an image-assisted fundus examination, in random order. During the image-assisted method, ultrawide field scanning laser ophthalmoscopic images were reviewed in conjunction with a dilated fundus examination. Lesions detected by each method were assigned to one of three regions, ie, optic disc, posterior pole/macula, or mid-to-peripheral retina. Discrepancies between the image-assisted and the traditional examination methods were adjudicated by a retinal ophthalmologist. In total, 170 subjects (339 eyes) were recruited. Agreement between image-assisted and traditional fundus examination varied by lesion type and was excellent for staphyloma (kappa 0.76), fair for suspicious cupping (kappa 0.66), drusen in the posterior pole/macula and mid-to-peripheral retina (0.45, 0.41), retinal pigment epithelial changes in the posterior pole/macula (0.54), peripheral retinal degeneration (0.50), cobblestone (0.69), vitreoretinal interface abnormalities (0.40), and vitreous lesions (0.53). Agreement was poor for hemorrhage in the mid-to-peripheral retina (kappa 0.33), and nevi in the mid-to-peripheral retina (0.34). When the methods disagreed, the results indicated a statistically significant advantage for the image-assisted examination in detecting suspicious cupping (P = 0.04), drusen in the posterior pole/macula and mid-to-peripheral retina (P = 0.004, P < 0.001), retinal pigment epithelial changes in the posterior pole/macula (P = 0.04), nevi in the posterior pole/macula and mid-to-peripheral retina (P = 0.01, P = 0.007), peripheral retinal degeneration (P < 0.001), hemorrhage in the mid-to-peripheral retina (P = 0.01), and vitreous lesions (P < 0.001). Image-assisted fundus examination may enhance detection of retinal lesions compared with traditional fundus examination alone.