Ultra-wide Field Research Articles

THERAPEUTIC REFRACTIVE VITRECTOMY (TRV) FOR THE MANAGEMENT OF VITREOUS FLOATERS AND OPACITIES (VFO) ASSESSED BY THE STANDARDIZED AND KINETIC ANATOMICAL AND FUNCTIONAL TESTING OF VITREOUS FLOATERS AND OPACITIES (SK VFO TEST).

Propose new terminology and evaluate the effectiveness of Therapeutic Refractive Vitrectomy (TRV) for selective removal of vitreous floaters and opacities (VFO) utilizing Standardized Kinetic Anatomical Functional Testing of VFO (SK VFO Test) and new ultra widefield (UWF) OCT imaging techniques. Retrospective analysis. Twenty eyes underwent TRV for symptomatic VFO. Pre-/post-TRV assessments: SK-VFO Test, including straylight measurements (HD Analyzer, Light Disturbance Analyzer, C-Quant) alongside non-contact imaging including a new UWF OCT to evaluate changes in vitreous anatomical and optical properties. Post-TRV evaluations indicated objective changes in vitreous optical properties and subjective measures. Reduced straylight measurements: HDA 22%, LDA 54.4% (p=0.013), and C-Quant 7.8% (p=0.034). Patient reported outcomes statistically significantly improved (p=0.022). Corrected distance visual acuity (CDVA) changes were marginal. New UWF 26 mm with a 12 mm imaging window OCT facilitated detailed vitreous imaging, confirming status of posterior vitreous detachment (PVD) (100%). Post-TRV UWF and OCT imaging demonstrated restoration of vitreous clarity, confirmed presence of residual cortical vitreous and absence of new PVDs. TRV is a significant contribution for therapeutic refractive surgery as a safe and effective approach to enhancing visual quality, correcting refractive and opaque vitreous anomalies. Improvement in CDVA was minimal representing limited effectiveness as a measure of comprehensive visual function. Improvements in objective straylight measures and imaging are in alignment with subjective symptom improvements post-TRV. This underscores the utility and value of new holistic evaluation methods beyond traditional metrics to assess the impact of TRV on visual function and quality of life.

Longitudinal Assessment of AMD using Ultrawide Field Imaging – The Optos PEripheral RetinA (OPERA) Follow-up Study

PurposeWith the widespread availability of ultrawide field imaging, peripheral retinal abnormalities in age-related macular degeneration (AMD) have garnered attention. However, longitudinal studies on AMD peripheral findings are limited. This study aims to characterize and quantify these features over five years. DesignLongitudinal ancillary study. ParticipantsOptos PEripheral RetinA (OPERA) is an ancillary study of the Age-Related Eye Disease Study 2. A total of 137 OPERA participants (265 eyes) with gradable ultrawide field (UWF) color and autofluorescence imaging at year 5 (Y5) and year 10 (Y10) were included. MethodsUWF color and autofluorescence images were captured using Optos ultrawide field devices (Optos, Dunfermline, Scotland) and graded at the Wisconsin Reading Center for macular and peripheral AMD features using the 3-zone OPERA grid. Main Outcome MeasuresPresence of peripheral retinal lesions (Neovascular AMD, geographic atrophy (GA), drusen, increased pigment, decreased pigment, reticular pseudodrusen, reticular pigmentary changes, and cobblestone degeneration) and their association with central AMD progression. ResultsUWF color: In zone 1 at Y5, AMD severity scale (AMDSS) was ≤5 in 8%, 6-8 in 49%, noncentral and central GA in 15%, and neovascular AMD in 28%. In zone 1 at Y10, AMDSS was ≤5 in 6%, 6-8 in 30%, noncentral and central geographic atrophy in 27%, and neovascular AMD in 37%. In zone 2, peripheral AMD abnormalities in Y5 versus Y10 included: drusen 99% vs 99%, hyperpigmentation 11% vs 11%, and hypopigmentation 4% vs 7% respectively. Non-AMD peripheral degenerations were present in Y5 versus Y10: cobblestone 19% vs 30% and reticular pigmentary changes 25% vs 33% respectively. Among eyes with AMDSS 6-8 at Y5, progression to late AMD occurred in 41% without substantial peripheral findings and 41% with such findings, which include drusen of ≥1 disc area and/or any hypo or hyperpigmentation in zones 2 or 3. UWF autofluorescence: Reticular autofluorescence pattern was present in 22% of eyes at Y5 and 39% at Y10 with 5% and 6% of cases being most prominent outside of zone 1. GA was present in 53 eyes with mean area of 3.4mm2 (SD = 5.4) at Y5 and 91 eyes with mean area 7.7mm2 (SD = 9.7) at Y10. ConclusionsThe OPERA study reveals that AMD features often extend beyond the macula, suggesting that AMD is a panretinal disease. In this study peripheral findings were not associated with increased risk of progression to late AMD.

Unsupervised Learning-Assisted Acoustic-Driven Nano-Lens Holography for the Ultrasensitive and Amplification-Free Detection of Viable Bacteria.

Bacterial infection is a crucial factor resulting in public health issues worldwide, often triggering epidemics and even fatalities. The accurate, rapid, and convenient detection of viable bacteria is an effective method for reducing infections and illness outbreaks. Here, an unsupervised learning-assisted and surface acoustic wave-interdigital transducer-driven nano-lens holography biosensing platform is developed for the ultrasensitive and amplification-free detection of viable bacteria. The monitoring device integrated with the nano-lens effect can achieve the holographic imaging of polystyrene microsphere probes in an ultra-wide field of view (∽28.28mm2), with a sensitivity limit of as low as 99nm. A lightweight unsupervised learning hologram processing algorithm considerably reduces training time and computing hardware requirements, without requiring datasets with manual labels. By combining phage-mediated viable bacterial DNA extraction and enhanced CRISPR-Cas12a systems, this strategy successfully achieves the ultrasensitive detection of viable Salmonella in various real samples, demonstrating enhanced accuracy validated with the qPCR benchmark method. This approach has a low cost (∽$500) and is rapid (∽1h) and highly sensitive (∽38CFUmL-1), allowing for the amplification-free detection of viable bacteria and emerging as a powerful tool for food safety inspection and clinical diagnosis.

112° field of view high-resolution swept-source OCT angiography for rat retinas.

This study introduces an ultra-wide field (UWF) and high-resolution swept-source optical coherence tomographic angiography (OCTA) system for rat retinal imaging. Using an asymmetrical optics design, the system achieves unprecedented details of retinal structures and vascular plexuses over a large field of view (112°) in a single-shot acquisition. Views of single-nerve fiber bundles and single capillary vessels are consistently visible over a 112° field of view. The system has a long imaging range and high penetration and allows a full view of vitreous hyaloid vessels, retina, choroid, sclera, and posterior ciliary arteries, down to sub-sclera connective tissues. In a longitudinal study of oxygen-induced retinopathy (OIR) in rats, the system successfully revealed the progression and regression of OIR-related vascular pathologies, such as ischemia, neovascularization, and tortuosity. To our knowledge, this novel UWF-OCT/OCTA prototype designed for rat retinal imaging will be a vital tool for monitoring disease progression and evaluating therapeutic interventions in preclinical models.

Comparison of Geographic Atrophy Measurements Between Blue-Light Heidelberg Standard Field and Green-Light Optos Ultrawide Field Autofluorescence.

This study compared geographic atrophy (GA) measurements in the macula using standard 30° field and ultrawide field (UWF) fundus autofluorescence (FAF) imaging. Participants from Age-Related Eye Disease Study 2 (AREDS2) and Optos PEripheral RetinA (OPERA) studies with GA were included for comparison between standard field FAF with Heidelberg Spectralis and Optos 200Tx UWF FAF. Two time points 5years apart were evaluated. GA area (mm2) was recorded in the macular area for both imaging types and in the peripheral field for UWF. Of 102 paired images (73 subjects), the mean (SD) baseline GA area was 5.32 (6.36)mm2 with standard and 4.79 (5.87)mm2 with UWF FAF (P < 0.001). The mean difference between the two modalities was 0.52mm2 (95% confidence interval, -2.41 to 1.37). Progression of GA in 25 eyes over 5years showed a median annual growth rate of 1.28mm2 (range, 0.02 to 4.7) for standard and 1.34mm2 (range, 0.04 to 5.3) for UWF FAF (P = 0.49). The measurement of GA is larger on standard than on UWF FAF imaging. The observed difference may be due to image averaging and the use of blue versus green FAF. Similar GA progression with standard and UWF FAF suggests either may be used longitudinally, although not interchangeably. Further investigation is required with updated UWF technology. With the increasing adoption of UWF imaging modalities, this study suggests that Optos UWF FAF may be used longitudinally as an alternative to standard field FAF to monitor GA.

Retinopathy in Mucopolysaccharidoses.

PurposeTo determine the pattern(s) of onset, variation, and progression of retinopathy in patients with Mucopolysaccharidosis (MPS). DesignProspective, longitudinal, observational study. ParticipantsBetween November 2015 and March 2023, individuals with MPS were recruited from Ophthalmology clinics at the Manchester Royal Eye Hospital, United Kingdom. MethodsParticipants underwent assessment of visual acuity, corneal clouding, intraocular pressure, along with fundoscopy, ultra-widefield (UWF) colour fundus photography, fundus autofluorescence (FAF) imaging, optical coherence tomography (OCT), and electroretinography (ERG), where feasible. Main Outcome MeasuresEvaluation of findings from clinical examination, retinal imaging, and electroretinogram studies, to ascertain the presence and patterns of retinopathy. ResultsData was collected for 75 patients, including 45 MPS I, 9 MPS II, 13 MPS IVA, and 8 MPS VI, aged 3-58 years. Fundus photography was conducted in 65 patients, FAF in 61, OCT in 58, and electrodiagnostic studies in 36 participants. Retinopathy was defined as signs of retinal disease evident through retinal examination or fundus photography such as depigmentation, bone-spicule pigmentation, vascular tortuosity, retinal pigment epithelium (RPE) mottling/other changes, macular atrophy/puckering/epiretinal membranes, FAF findings such as a central hyperautofluorescent dot, hyperautofluorescent parafoveal ring, hypoautofluorescent lesions around fovea (double bull’s eye), areas of hyper/hypoautofluorescence, and extrafoveal changes, OCT imaging features such as central external limiting membrane (ELM) thickening, RPE disturbance, photoreceptor layer loss, parafoveal retinal atrophy, and outer retinal/intrachoroidal cavities, or electroretinogram studies revealing rod-mediated retinopathy or rod-cone dystrophy. Retinopathy was confirmed in 32 patients, including 25 MPS I, 4 MPS II, 1 MPS IVA, and 2 MPS VI. Five participants were first diagnosed with retinopathy with clinical examination, while 31 participants were identified on UWF colour fundus photography supported by FAF and OCT. 21 patients exhibited ERG abnormalities consistent with retinopathy. Fifteen of the total 32 participants described symptoms of nyctalopia. The onset of retinopathy varied substantially, with initial detection between 2 and 53 years of age. ConclusionsMPS patients as young as 2 may develop retinopathy, diagnosed through fundus examination, ophthalmic imaging, or ERG. Emerging treatments, including gene therapy, may prevent or stabilise retinopathy. Phenotypic data and natural history of MPS-related retinopathy are thus of paramount importance.

Author's Response: Ultrawide field angiography in proliferative diabetic retinopathy.

Author's Response: Ultrawide field angiography in proliferative diabetic retinopathy.

Intraretinal Microvascular Abnormalities in Eyes with Advanced Stages of Nonproliferative Diabetic Retinopathy: Comparison Between UWF-FFA, CFP, and OCTA-The RICHARD Study.

This study aimed to evaluate intraretinal microvascular abnormalities (IRMA) in eyes with advanced nonproliferative diabetic retinopathy (NPDR) using multimodal approach in co-located areas focusing on central retina (up to 50°) and to look at possible correlations between IRMA and other structural changes, like ischemia and presence of microaneurysms. The RICHARD study (NCT05112445) included 60 eyes from 60 patients with type2 diabetes with moderate-severe NPDR, diabetic retinopathy severity levels 43, 47, and 53 (DRSS). IRMA were defined as capillary tortuosity covering a minimum circular area of 300µm (calculated to correspond to the Early Treatment Diabetic Retinopathy Study standard photo 8A) and were identified using multimodal imaging with distinct fields of view (FoV): color fundus photography (CFP) using a Topcon TRC-50DX camera (Topcon Medical Systems, Japan), Optos California ultra wide field fundus fluorescein angiography (UWF-FFA) (Optos plc, UK), and swept-source optical coherence tomography angiography (SS-OCTA) (PLEX® Elite 9000, ZEISS, USA). Different areas of the retina were examined: central macula (up to 20°) and posterior pole (between 20° and 50°). Multimodal imaging was used to identify IRMA in co-located areas (FoV < 50°) including UWF-FFA, CFP, and SS-OCTA. In eyes with DRSS levels 47 and 53, IRMA were identified in both areas of the retina, while in eyes with DRSS level 43, IRMA were detected only outside of the central macula (FoV > 20°). Our results show that when evaluating the presence of IRMA (FoV < 50°), UWF-FFA detected 203 IRMA, SS-OCTA detected 133 IRMA, and CFP detected 104 IRMA. Our results also show that the presence of IRMA was positively associated with presence of microaneurysms. Identification of IRMA in eyes with advanced NPDR is better achieved by UWF-FFA than CFP and SS-OCTA. A statistically significant correlation was found between the presence of IRMA and the increase in number of microaneurysms. ClinicalTrials.gov, identifier NCT05112445.

Loss of Peripheral Retinal Vessels in Retinitis Pigmentosa.

Retinitis pigmentosa (RP) is the most common inherited retinal disease and a major cause of irreversible vision loss. The purpose of this study was to assess peripheral retinal vessels in RP. Cross-sectional study. Patients with RP and age-matched controls. Using ultra-wide field fundus images, the retina was divided into three zones: posterior, mid periphery, and far periphery. To evaluate vascularity of the retina, the vessels were counted at the border of posterior and mid peripheral zones (Z1/2) and the border of mid peripheral and far peripheral zones (Z2/3). Vessel counts at Z1/2 and Z2/3. 181 eyes of 107 RP patients and 130 eyes of 84 controls were included. In the RP group, the median vessel counts at Z1/2 and Z2/3 were 8 and 3, respectively. These were strikingly lower than the control group with the median vessels of 42 and 43.5 at Z1/2 (p<0.001) and Z2/3 (p<0.001), respectively. 22% of RP eyes were entirely avascular in the far periphery and 7% were avascular in the mid periphery and far periphery. Only 5% of RP eyes had more than 25 vessels at Z2/3. There were significantly fewer vessels in the temporal retina at both Z1/2 (p=0.01) and Z2/3 (p<0.001) in RP eyes. Furthermore, eyes with visual acuity of 20/200 or worse had significantly fewer vessels at Z1/2 (p<0.001) and Z2/3 (p<0.001). There were no significant differences in the number of vessels at Z1/2 and 2/3 between the right and left eyes of RP patients with both eyes included in the study. This study provides compelling evidence of substantial symmetrical peripheral retinal vascular loss in RP. This finding may aid in clinical diagnosis of the disease and have significant therapeutic implications.

Influence of vortex vein engorgement for photodynamic therapy in central serous chorioretinopathy

This study evaluates the efficacy of photodynamic therapy (PDT) in treating central serous chorioretinopathy (CSC) based on the number of engorged vortex vein draining macula visualized on ultra-widefield (UWF) indocyanine green angiography (ICGA). Thirty-six eyes of 36 patients with treatment-naïve CSC were included. Macula-draining vortex veins were assessed in each quadrant using UWF ICGA. The resolution of subretinal fluid (SRF), pigment epithelial detachment (PED), ellipsoid zone (EZ) disintegrity, and retinal pigment epithelium (RPE) irregularity were evaluated at 3 months after PDT. Visual and anatomical improvements were monitored for 12 months. Logistic regression analysis was performed to identify factors associated with poor visual outcomes. A higher number of macula-draining vortex vein was associated to persistent SRF (p = 0.004), PED (p = 0.001), EZ disintegrity (p = 0.011), and RPE irregularity (p = 0.001). Macula-draining vortex veins were also correlated with poor EZ restoration and limited best corrected visual acuity (BCVA) improvements. In multivariate analysis, the number of macula-draining vortex vein (B = 0.197, p = 0.047) was a risk factor for worse BCVA at 12 months. Increased macula-draining vortex vein was related with unfavorable anatomical and poor visual outcomes after PDT in CSC patients.

Wagner Syndrome-like fundus presentation of atypical Persistent Fetal Vasculature.

To report the case of a woman with atypical Persistent fetal vasculature (PFV) accompanied by more typical findings of Wagner Syndrome. A 58-year-old woman complained about persistent flashes and floaters for more than 6 months. Multimodal retinal imaging showed Bergmeister papilla and a fibrous gray strand floating behind the macula in the right eye. Ultra-wide field retinography revealed a 270° paving-stone degeneration and a nasal circumferential vitreous veil in both eyes. Functional and genetic testing were negative for inherited retinal diseases. PFV spectrum confirms its heterogeneous presentation. We report an atypical adult PFV case in presence of retrolental and optic nerve head stalks, accompanied by extensive peripheral vitreoretinal degenerations. This case may expand the current understanding of PFV presentation in adulthood.

Reassessment of arterial versus venous perfusion of diabetic retinal neovascularization using ultrawide-field fluorescein angiography.

The purpose of this study was to assess whether diabetic NV is perfused by the arterial or the venous circulation. This is a retrospective, consecutive case series evaluating patients with proliferative diabetic retinopathy (PDR) imaged with ultrawide-field (UWF) fluorescein angiography (FA). Areas of neovascularization elsewhere (NVE) and neovascularization of the disc (NVD) were assessed. Perfusion was defined as arterial, arteriovenous, or venous if the area of diabetic neovascularization (NV) began to hyperfluoresce either prior, during, or after laminar venous flow, respectively. A total of 180 eyes from 176 patients with 928 NV were identified (830 NVE, 98 NVD). Of those, 5.1% of NVE were classified as arterial and 58.2% of NVD were classified as arterial. The remaining NV were classified as arteriovenous except for a small subset (6.1%) which were indeterminate. None of the NV were classified as venous. Noteworthy examples demonstrated NV that nearly fully perfused prior to any detectable fluorescence within nearby veins as well as clear shunting of blood from a feeding artery to a draining vein. UWF FA images suggest that some NV is perfused by retinal arteries. This may be useful in devising strategies for early detection and treatment of NV precursors. What is known • Diabetic retinal neovascularization has long been thought to be perfused by the retinal venous circulation. • Vascular endothelial growth factor has been shown to play key roles in both angiogenesis and arteriogenesis. What is new • Ultrawide-field fluorescein angiography demonstrates that at least some diabetic neovascularization is perfused by the retinal arterial circulation. • This supports the hypothesis that diabetic neovascularization may arise from arterially-perfused intraretinal microvascular abnormalities in the capillary bed.

Paediatric staphyloma classification: new perspectives via ultrawide field three-dimensional swept-source optical coherence tomographic angiography

AimTo employ ultrawide field three-dimensional swept-source optical coherence tomographic angiography (UWF 3D SS-OCTA) modality, integrating novel strategies, posterior eye curvature maps and posterior eye height maps, in characterising the features...

Fundus screening for peripheral retinal lesions in myopic patients before refractive surgery using ultra-wide field scanning laser ophthalmoscopy

Purpose The aim of this study was to evaluate the ultra-wide field (UWF) scanning laser ophthalmoscopy using the Optomap 200Tx (Optos) in detecting peripheral retinal lesions in myopic patients. Patients and methods A prospective cross-sectional observational study was conducted from June 2023 to March 2024 at the Department of Ophthalmology, Alexandria University, Alexandria, Egypt. It included 162 eyes of 81 myopic patients (35 males and 46 females). The mean age of the participants was 23.85±3.81 years (range=18–33 years). The mean spherical equivalent of the refractive error was −4.83±1.38 D (range=−1.50 to −7.75 D). All patients were subjected to full ophthalmic assessment. UWF scanning laser ophthalmoscopy using Optomap 200Tx (Optos) without pupillary dilatation with both standard and eye-steering imaging was done and the findings were compared to findings of the dilated fundus examination with slit-lamp biomicroscopy using a 90 D fundus lens. Results Variable degrees of tessellated fundus were observed in 38.3% of the cases with the mydriatic slit-lamp fundus examination with 90 D lens and in 39.5% with Optomap (Optos) imaging, with no statistically significant difference (P=0.837). Similarly, peripheral pigmentary degenerations were noted in 28.4% and in 30.2% of the cases, respectively, with no significant difference between the two methods (P=0.708). Lattice degenerations were identified in 19.8% and in 20.4% of the cases, respectively, with no significant difference (P=0.825). White without pressure lesions were present in 5.5 and 6.8% of the cases, respectively, with no significant difference (P=0.695). Additionally, atrophic holes and vitreoretinal adhesions were observed in 0.6% of the cases using both methods, indicating no significant difference (P=1.000). Conclusion Optomap 200Tx (Optos) UWF imaging using the eye-steering technique was a valuable method for detecting peripheral retinal lesions in myopic patients.

Prevalence and spectrum of manifestations of tamoxifen retinopathy as assessed by multimodal and ultra-widefield retinal imaging

Background/ObjectivesTamoxifen has well-known retinal toxicity, but the epidemiology of this toxicity is poorly defined. This study aims to 1) evaluate the prevalence of tamoxifen retinopathy in a major northeastern metropolitan area based on multimodal retinal imaging and 2) determine whether the additional peripheral retina captured in ultra-widefield (UWF) imaging aids in the diagnosis of tamoxifen retinopathy. MethodsThis retrospective cohort study examined female patients initiated on tamoxifen for at least 12 months prior to their first retinal exam. Two independent graders performed blinded review of spectral-domain optical coherence tomography (OCT) images for evidence of macular toxicity and UWF images for signs of central and peripheral toxicity. A one-tailed two-proportion Z-test determined whether peripheral pigmentary changes were more prevalent in the tamoxifen cohort than age- and gender-matched controls. Results241 eyes from 123 patients were included in the tamoxifen cohort, and 258 eyes from 132 patients were included in the control cohort. Two patients demonstrated definitive tamoxifen retinopathy, for a prevalence of 1.6%. One patient demonstrated crystalline maculopathy on OCT and UWF imaging, while another demonstrated pseudocystic cavitations on OCT imaging. Neither patient had peripheral findings on UWF imaging. Peripheral pigmentary changes were not significantly more prevalent in the tamoxifen cohort. ConclusionsThese findings suggest that UWF imaging does not contribute to diagnosis of tamoxifen retinopathy, and OCT may be the most valuable tool in diagnosing tamoxifen retinopathy. Our prevalence (1.6%) diverges from higher rates in studies screening with similarly advanced retinal imaging. Further large population studies are needed.

The Current and Novel Imaging Modalities for Ocular Vasculitis in Behcet's Disease: A Review.

Behcet's syndrome is a multisystem inflammatory disorder characterized by a chronic relapsing course and diverse clinical manifestations, prominently affecting young adults along the ancient Silk Road and beyond. The disease pathogenesis involves complex interactions between genetic predisposition, environmental triggers, and dysregulated immune responses, leading to systemic vasculitis and tissue damage. Ocular involvement, a hallmark of Behcet's Disease (BD), significantly impacts morbidity, with uveitis as a common initial presentation that can progress to severe vision-threatening complications like retinal vasculitis and occlusive disease. This review consolidates current knowledge on ocular manifestations in BD, emphasizing the pivotal role of multimodal imaging in diagnostic evaluation and management. Fundus photography serves as a baseline tool for documenting intraocular lesions and monitoring treatment responses. Fluorescein angiography remains the gold standard for detecting acute inflammatory changes and vascular leakage patterns essential for disease staging and prognostication. Recent advancements in imaging, such as ultra-wide field imaging (UWF), indocyanine green angiography (ICGA), Doppler ultrasonography, Optical Coherence Tomography (OCT), OCT angiography (OCTA), adaptive optics (AO), and retinal function imaging (RFI), provide unprecedented insights into microvascular dynamics, structural changes, and functional impairments associated with ocular BD. Integration of these advanced imaging modalities enhances early detection of subclinical disease, facilitates precise localization of inflammatory lesions, guides therapeutic interventions, and monitors treatment efficacy. OCT and OCTA, in particular, offer non-invasive, high-resolution assessments of macular edema, vascular perfusion abnormalities, and choroidal thickness alterations critical for optimizing patient care. In conclusion, multimodal imaging represents the cornerstone in the comprehensive management of ocular manifestations in Behcet's Disease, offering clinicians invaluable tools for accurate diagnosis, treatment planning, and long-term monitoring of disease progression and treatment outcomes.

DIABETIC RETINOPATHY LESION TYPES AND DISTRIBUTION ON ULTRAWIDE FIELD IMAGING AND THE RISK OF DISEASE WORSENING OVER TIME.

To evaluate the effect of diabetic retinopathy (DR) lesion type (hemorrhages and/or microaneurysms, intraretinal microvascular abnormalities, new vessels elsewhere, and venous beading), severity, and distribution on disease worsening based on the Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale. Post hoc analysis of a multicenter observational study of 544 eyes with nonproliferative DR and an Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale score of Level 35 to 53. Disease worsening was defined as Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale worsening by ≥2 steps from baseline or receipt of DR treatment over 4 years. DR lesions were evaluated based on the entire visible area in the ultrawide field color (UWF-color) and UWF-fluorescein angiography images. A significantly greater risk of disease worsening was associated with the presence of more severe lesion grades outside the Early Treatment Diabetic Retinopathy Study fields for hemorrhages and/or microaneurysms (hazard ratio: 1.74 [95% confidence interval, 1.28-2.36]) on UWF-color and for hemorrhages and/or microaneurysms (1.90 [1.38-2.61]), intraretinal microvascular abnormalities (1.68 [1.13-2.49]), and new vessels elsewhere (1.99 [1.36-2.93]) on UWF-fluorescein angiography. These results suggest that features on UWF-color and UWF-fluorescein angiography may provide additional prognostic value in determining the risk of disease worsening. The use of UWF-fluorescein angiography improves identification of DR lesions and disease progression. However, the optimal method of disease risk assessment on UWF imaging still needs to be determined.

Automatic Segmentation of Hemorrhages in the Ultra-wide Field Retina: Multi-scale Attention Subtraction Networks and An Ultra-wide Field Retinal Hemorrhage Dataset.

Ultra-wide field (UWF) retinal imaging can improve the detection rate of retinal hemorrhage as compared with conventional fundus images. However, hemorrhages in UWF retinal images can also become smaller and more widely distributed, which can be time consuming and labor intensive. With the development of computer technology, automatic segmentation techniques can assist physicians in diagnosis. However, the lack of publicly available UWF retinal hemorrhage segmentation datasets has limited the development of automatic hemorrhage segmentation techniques in UWF retinal images. We present a large-scale high-quality UWF retinal hemorrhage segmentation dataset, named UWF-RHS Dataset, for public use. To the best of our knowledge, we are the first team to make the UWF retinal hemorrhage segmentation dataset publicly available. In addition, we propose a multi-scale attention subtraction network (MASNet) for UWF retinal hemorrhage segmentation. Specifically, highly focused lesion features are extracted by using the proposed multi-scale attention subtraction (MAS) module at the progress of the skip-connection. Several comparative experiments and ablation experiments were performed at the UWF-RHS Dataset, and all experiments state that our proposed method is effective in diagnosing retinal hemorrhages with state-of-the-art results. The proposed UWF-RHS dataset and MASNet will greatly facilitate the development of automated segmentation techniques for UWF retinal hemorrhages. Links to the UWF-RHS dataset and the MASNet model code are available fromhttps://github.com/wurenkai/UWF-RHS-Dataset-and-MASNet.

ETDRS grading with CLARUS ultra-widefield images shows agreement with 7-fields colour fundus photography

BackgroundTo analyse and compare the grading of diabetic retinopathy (DR) severity level using standard 35° ETDRS 7-fields photography and CLARUS™ 500 ultra-widefield imaging system.MethodsA cross-sectional analysis of retinal images of patients with type 2 diabetes (n = 160 eyes) was performed for this study. All patients underwent 7-fields colour fundus photography (CFP) at 35° on a standard Topcon TRC-50DX® camera, and ultra-widefield (UWF) imaging at 200° on a CLARUS™ 500 (ZEISS, Dublin, CA, USA) by an automatic montage of two 133° images (nasal and temporal). 35° 7-fields photographs were graded by two graders, according to the Early Treatment Diabetic Retinopathy Study (ETDRS). For CLARUS UWF images, a prototype 7-fields grid was applied using the CLARUS review software, and the same ETDRS grading procedures were performed inside that area only. Grading of DR severity level was compared between these two methods to evaluate the agreement between both imaging techniques.ResultsImages of 160 eyes from 83 diabetic patients were considered for analysis. According to the 35° ETDRS 7-fields images, 22 eyes were evaluated as DR severity level 10–20, 64 eyes were evaluated as DR level 35, 41 eyes level 43, 21 eyes level 47, 7 eyes level 53, and 5 eyes level 61. The same DR severity level was achieved with CLARUS 500 UWF images in 92 eyes (57%), showing a perfect agreement (k > 0.80) with the 7-fields 35° technique. Fifty-seven eyes (36%) showed a higher DR level with CLARUS UWF images, mostly due to a better visualization of haemorrhages and a higher detection rate of intraretinal microvascular abnormalities (IRMA). Only 11 eyes (7%) showed a lower severity level with the CLARUS UWF system, due to the presence of artifacts or media opacities that precluded the correct evaluation of DR lesions.ConclusionsUWF CLARUS 500 device showed nearly perfect agreement with standard 35° 7-fields images in all ETDRS severity levels. Moreover, CLARUS images showed an increased ability to detect haemorrhages and IRMA helping with finer evaluation of lesions, thus demonstrating that a UWF photograph can be used to grade ETDRS severity level with a better visualization than the standard 7-fields images.Trial registrationApproved by the AIBILI - Association for Innovation and Biomedical Research on Light and Image Ethics Committee for Health with number CEC/009/17- EYEMARKER.

Developing an image-based grading scale for peripheral drusen to investigate associations of peripheral drusen type with age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness. It is associated with peripheral drusen which has not been categorized. We investigated peripheral drusen to validate an image grading system and to understand possible associations between peripheral drusen and AMD. We collated clinical data, ultra-widefield (UWF) pseudocolor fundus images and Spectral-Domain Optical Coherence Tomography (SD-OCT) scans from consecutive retinal patients. SD-OCT scans were used to determine AMD stage. A masked retinal specialist recorded the types of peripheral drusen observed in UWF images. Eyes whose UWF images did not pass quality screening and those without AMD and peripheral drusen were excluded from the study. Statistical tests were utilized to determine the validity of our grading system and associations of peripheral drusen with AMD. A total of 481 eyes (283 subjects) were included in the study (mean age 73.1 ± 1.2years, 64.3% female). Interobserver and test–retest statistical analyses to evaluate the UWF image grading system resulted in Cohen’s Kappa 0.649 (p < 0.001) and 0.922 (p < 0.001) respectively. A total of 284 (59.0%), 28 (5.8%), 15 (3.1%), 22 (4.6%), 4 (0.8%), 39 (8.1%), and 32 (6.7%) eyes had hard, soft, reticular, cuticular, atrophic, mixed drusen, and mixed drusen and atrophy respectively in at least one peripheral retinal quadrant. Hard peripheral drusen was significantly associated with the presence of AMD (p = 0.010). Peripheral drusen types were variably seen in retinal patients with and without AMD. We validated a peripheral drusen grading system and provided an image library to assist in the identification of peripheral drusen. Our study found an association between peripheral hard drusen and an AMD diagnosis but did not find a link between peripheral drusen and severity of AMD.