Wide-field Scanning Laser Ophthalmoscopy Research Articles

The use of artificial intelligence to assess diabetic eye disease among the Greenlandic population

ABSTRACT Background: Retina fundus images conducted in Greenland are telemedically assessed for diabetic retinopathy by ophthalmological nurses in Denmark. Applying an AI grading solution, in a Greenlandic setting, could potentially improve the efficiency and cost-effectiveness of DR screening. Method: We developed an AI model using retina fundus photos, performed on persons registered with diabetes in Greenland and Denmark, using Optos® ultra wide-field scanning laser ophthalmoscope, graded according to ICDR. Using the ResNet50 network we compared the model’s ability to distinguish between different images of ICDR severity levels in a confusion matrix. Results: Comparing images with ICDR level 0 to images of ICDR level 4 resulted in an accuracy of 0.9655, AUC of 0.9905, sensitivity and specificity of 96.6%. Comparing ICDR levels 0,1,2 with ICDR levels 3,4, we achieved a performance with an accuracy of 0.8077, an AUC of 0.8728, a sensitivity of 84.6% and a specificity of 78.8%. For the other comparisons, we achieved a modest performance. Conclusion: We developed an AI model using Greenlandic data, to automatically detect DR on Optos retina fundus images. The sensitivity and specificity were too low for our model to be applied directly in a clinical setting, thus optimising the model should be prioritised.

THE WAY PATIENTS SEE FLOATERS: Widefield Dynamic Scanning Laser Ophthalmoscopy Imaging of Vitreous Abnormalities.

To investigate the use of dynamic widefield scanning laser ophthalmoscopy (SLO) and B-scan ultrasonography in imaging vitreous abnormalities in patients with complaints of floaters. Twenty-one patients underwent both dynamic SLO and B-scan ultrasonography to image their vitreous abnormalities. After reviewing these videos, patients graded each imaging technique on a scale of 1 to 10, based on how closely it represented their visual perception of floaters. The mean age of the patients (12 women and nine men) was 47.7 ± 18.5 years. The patients graded a median score of nine for SLO imaging (mean = 8.43) compared with a median score of 5 (mean = 4.95) for ultrasound ( P = 0.001). Widefield SLO imaging demonstrated three-dimensional interconnectivity within the condensations of the formed vitreous that exhibited translational and rotational movements with eye saccades. Floaters are a common complaint, but it is difficult to know whether imaging findings of the vitreous correlate to what patients perceive. Widefield SLO seems to image vitreous abnormalities related to how patients perceive their own floaters better than B-scan ultrasonography. Despite the term "floaters", the vitreous abnormalities in the videos seemed to be manifestations of a complex three-dimensional degeneration of the vitreous framework.

Blue Widefield Images of Scanning Laser Ophthalmoscope Can Detect Retinal Ischemic Areas in Eyes With Diabetic Retinopathy.

To determine whether the hyporeflective areas in the blue images obtained by widefield scanning laser ophthalmoscopy (SLO) correspond to the non-perfused areas (NPAs) in the fluorescein angiograms (FA) in eyes with diabetic retinopathy (DR). Retrospective observational case series. Ninety patients with diabetes mellitus (DM) were studied. All had undergone multicolor widefield SLO imaging. The NPAs in the FA images and hyporeflective areas in the blue widefield SLO images were examined. The morphology of the retina was determined by optical coherence tomography. Hyporeflective areas in the blue SLO images were found with a rate of 76.6% in eyes with proliferative DR eyes. In a comparison of the hyporeflective areas of the blue SLO images to the non-perfused areas in the FA images, the appearance and the correspondence in the locations of these two types of images were found, and the rate was highly concordant with a Cohen's kappa value of 0.675. The high concordance between the hyporeflective areas in the widefield blue SLO and the NPAs in the FA indicates that widefield blue SLO can be used to identify ischemic retinal areas in eyes with DR without the intravenous injection of any dye.

Combined high contrast and wide field of view in the scanning laser ophthalmoscope through dual detection of light paths.

We demonstrate a multimode detection system in a scanning laser ophthalmoscope (SLO) that enables simultaneous operation in confocal, indirect, and direct modes to permit an agile trade between image contrast and optical sensitivity across the retinal field of view to optimize the overall imaging performance, enabling increased contrast in very wide-field operation. We demonstrate the method on a wide-field SLO employing a hybrid pinhole at its image plane, to yield a twofold increase in vasculature contrast in the central retina compared to its conventional direct mode while retaining high-quality imaging across a wide field of the retina, of up to 200deg and 20 μm on-axis resolution.

Fundus imaging in newborn children with wide-field scanning laser ophthalmoscope.

Current fundus imaging in newborn babies requires mydriatics, eye specula and corneal contact. We propose that a scanning laser ophthalmoscope (SLO) allows ultra wide-field imaging with reduced stress for the child. This prospective observational single centre study was conducted in Landspítali, University Hospital, Reykjavik, Iceland. In this study, a noncontact wide-field SLO (Optomap 200Tx) was used to image the retina in healthy full-term newborns without the use of mydriatics or eye specula. The child was held by one of the parents, while one of the researchers supported the child's head in front of the SLO camera for alignment and opened the eye with either a finger or a cotton tip. Fifty-nine participants were recruited (34 females). The mean age was 16days, and the mean gestational age was 40±1weeks at the time of imaging. Ultra-wide-field (200°) images were obtained of 44 participants. Twenty-seven participants (61%) had at least one ultra wide-field image with the optic disc and vessel segments in all quadrants of the fundus visible and in focus. No retinal pathology was found in the participants with the exception of one participant with small retinal haemorrhages. Scanning laser ophthalmoscope (SLO) ultra-wide-field fundus imaging is feasible in healthy full-term newborns without corneal contact, eye speculum or mydriatics. This approach could be an improvement for retinal imaging in newborn infants. Eye movement of the infant, whether asleep or awake, influenced which part of the fundus was captured, but focus and image quality were generally good.

DELINEATION OF CHOROIDAL AND RETINAL LESIONS IN POSTERIOR UVEITIS BY MULTISPECTRAL WIDE-FIELD SCANNING LASER OPHTHALMOSCOPY.

To investigate whether wide-field multispectral scanning laser ophthalmoscopy could assist in determining depth of chorioretinal pathology in posterior uveitis. Cross-sectional retrospective review of patients with birdshot chorioretinopathy (BCR; 42 eyes of 21 patients) or active primary vitreoretinal lymphoma (PVRL; 18 eyes of 10 patients) who had multispectral wide-field scanning laser ophthalmoscopy (Optos) images. Images acquired with 532 nm and 635 nm lasers were analyzed separately using Optos V Vantage Pro Review software. All 42 eyes with birdshot chorioretinopathy and 8/18 eyes with active primary vitreoretinal lymphoma had lesions on 635 nm imaging, while 26/42 of the birdshot chorioretinopathy eyes and 18/18 eyes with active primary vitreoretinal lymphoma had lesions on 532 nm imaging. The difference between the 2 groups on both 635 nm and 532 nm was statistically significant (P < 0.05). Retinal and choroidal lesions in patients with posterior uveitis can be differentially visualized with Optos 532 nm and 635 nm lasers, respectively, allowing determination of depth of pathology.

Comparison between Early Treatment Diabetic Retinopathy Study 7-field retinal photos and non-mydriatic, mydriatic and mydriatic steered widefield scanning laser ophthalmoscopy for assessment of diabetic retinopathy

AimsTo compare non-mydriatic, mydriatic and steered mydriatic widefield retinal images with mydriatic 7-field Early Treatment Diabetic Retinopathy Study (ETDRS)-standards in grading diabetic retinopathy (DR). MethodsWe examined 95 patients (190 eyes) with type 1 diabetes. A non-mydriatic, a mydriatic and four steered mydriatic 200° widefield retinal images were captured (Optos 200Tx, Optos plc, Dunfermline, Scotland) and compared to mydriatic 7-field 45° ETDRS images (Topcon 3D OCT-2000, Topcon, Tokyo, Japan). Images were graded for DR according to ETDRS-protocol by a trained and certified grader masked to the results of the corresponding grading. For agreement kappa-statistics were used. ResultsExact level agreement with 7-field images was found in 76.3%, 76.1% and 70.7% for non-mydriatic, mydriatic and steered mydriatic widefield images, respectively. Corresponding values for one-level agreement were 99.0%, 98.9% and 99.5%, respectively. Non-mydriatic matched mydriatic widefield images almost fully with exact and one-level agreement of 96.8% and 100.0%, respectively. Mydriatic steered images resulted in higher grading in 24 eyes. ConclusionsWidefield images matched 7-field images favorably. Widefield images can be captured without pupil-dilation and only one image is needed. However, because of overlapping eyelashes and distortion some lesion might be missed. Mydriatic steered images in selected cases may solve some of these problems.

Assessment of β-zone peripapillary atrophy by optical coherence tomography and scanning laser ophthalmoscopy imaging in glaucoma patients.

PurposeTo assess β-zone peripapillary atrophy (β-PPA) using spectral domain optical coherence tomography (SD-OCT), scanning laser ophthalmoscopy (SLO), and fundus auto-fluorescence (FAF) imaging in patients with primary open-angle glaucoma with advanced glaucomatous visual field defects.MethodsA consecutive, prospective series of 82 study eyes with primary open-angle glaucoma were included in this study. All study participants underwent a full ophthalmic examination followed by SD-OCT, wide-field SLO, and FAF imaging of the optic nerve head and the peripapillary region.ResultsEighty-four glaucomatous eyes were included in our prospective study. Correlation analyses for horizontally and vertically obtained β-PPA for all three imaging modalities (color SLO, FAF, and SD-OCT) revealed highest correlations between FAF and color SLO (Pearson correlation coefficient: 0.904 [P<0.001] for horizontal β-PPA and 0.786 [P<0.001] for vertical β-PPA). Bland–Altman plotting revealed highest agreements between color SLO and FAF, with −2.1 pixels ±1.96 standard deviation (SD) for horizontal β-PPA, SD: 10.5 pixels and 2.4 pixels ±1.96 SD for vertical β-PPA.Conclusionβ-PPA can be assessed using en-face SLO and cross-sectional SD-OCT imaging. Correlation analyses revealed highest correlations between color SLO and FAF imaging, while correlations between SLO and SD-OCT were weak. A more precise structural definition of β-PPA is needed.

Scanning laser ‘en face’ retinal imaging of epiretinal membranes

PurposeComparison of scanning laser ophthalmoscopy (SLO) based ‘en face’ imaging techniques of patients with epiretinal membranes (ERM) and evaluation of the accuracy of preoperative diagnostic imaging. MethodsA consecutive, prospective series of 53 study eyes of 46 patients with clinically diagnosed and in optical coherence tomography (OCT) confirmed symptomatic ERMs were included in this study. Spectral domain (SD-) OCT volume scans (20°×20° with 49 horizontal sections, ART 15) including SLO en face and fundus autofluorescence (FAF) images of the macula were obtained with HRA2 (Heidelberg Retina Angiograph-Optical Coherence Tomography, Heidelberg Engineering, Heidelberg, Germany). In addition, wide-field SLO color and FAF images (Optomap 200Tx, Optos PLC, Dunfermline, UK) were performed also covering the macular area. En face images of both devices were graded for each included study eye based on SD-OCT cross sectional scans. ResultsGrading of SD-OCT (HRA2) based SLO en face green–blue enhanced multi-color, green reflectance, blue reflectance and standard multi-color visualization revealed a better detectability of ERM than SD-OCT-based en face infrared or FAF images or wide-field SLO (Optomap) based pseudo-color, red laser separation, green laser separation, or FAF images. Both FAF visualizations, HRA2 and Optomap based, achieved low mean scores. SD-OCT based en face thickness map visualization revealed good visualization but poor demarcation of epiretinal membranes. ConclusionsIn summary, en face regular or enhanced multicolor SLO images acquired with HRA2 allow a better visualization of epiretinal membranes for preoperative evaluation compared to SD-OCT based en face thickness map or pseudo-color images acquired with Optomap while infrared or FAF images are least suitable to depict epiretinal membranes.

Nonmydriatic Ultra-Wide-Field Scanning Laser Ophthalmoscopy (Optomap) versus Two-Field Fundus Photography in Diabetic Retinopathy

The purpose of this study was to investigate the diagnostic properties of a 2-laser wavelength nonmydriatic 200° ultra-wide-field scanning laser ophthalmoscope (SLO) versus mydriatic 2-field 45° color fundus photography (EURODIAB standard) for assessing diabetic retinopathy (DR). A total of 143 consecutive eyes of patients with different levels of DR were graded regarding DR level and macular edema based on 2-field color photographs or 1 Optomap Panoramic 200 SLO image. All SLO images were nonmydriatic and all photographs mydriatic. Grading was performed masked to patient and clinical data. Based on photography, 20 eyes had no DR, 44 had mild, 18 moderate and 42 severe nonproliferative DR, and 19 eyes had proliferative DR. Overall correlation for grading DR level compared to Optomap SLO was moderate with kappa 0.54 (p < 0.001), fair-to-moderate in macular edema grading with kappa 0.39 (p < 0.001), and substantial for grading clinically significant macular edema (kappa 0.77). The wide-field SLO offers a wider field of view and can potentially better differentiate lesions by applying the 2 laser wavelengths. However, these advantages over 2-field fundus photography need to be confirmed in further studies.

Scanning Laser Ophthalmoscope Measurement of Local Fundus Reflectance and Autofluorescence Changes Arising from Rhodopsin Bleaching and Regeneration

We measured the bleaching and regeneration kinetics of rhodopsin in the living human eye with two-wavelength, wide-field scanning laser ophthalmoscopy (SLO), and investigated the effect of rhodopsin bleaching on autofluorescence intensity. The retina was imaged with an Optos P200C SLO by its reflectance of 532 and 633 nm light, and its autofluorescence excited by 532 nm light, before and after exposure to lights calibrated to bleach rhodopsin substantially. Bleaching was confined to circular retinal regions of 4.8° visual angle located approximately 16° superotemporal and superonasal to fixation. Images were captured as 12-bit tiff files and postprocessed to extract changes in reflectance and autofluorescence. At the locus of bleaching transient increases in reflectance of the 532 nm, but not the 633 nm beam were observed readily and quantified. A transient increase in autofluorescence also occurred. The action spectrum, absolute sensitivity, and recovery of the 532 nm reflectance increase were consistent with previous measurements of human rhodopsin's spectral sensitivity, photosensitivity, and regeneration kinetics. The autofluorescence changes closely tracked the changes in rhodopsin density. The bleaching and regeneration kinetics of rhodopsin can be measured locally in the human retina with a widely available SLO. The increased autofluorescence excited by 532 nm light upon bleaching appears primarily due to transient elimination of rhodopsin's screening of autofluorescent fluorochromes in the RPE. The spatially localized measurement with a widely available SLO of rhodopsin, the most abundant protein in the retina, could be a valuable adjunct to retinal health assessment.

Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis

To determine whether the use of ultra wide-field imaging changes the management or determination of disease activity in patients with noninfectious posterior uveitis. Prospective, observational case series. setting: Divisions of Retina and Ocular Immunology at single academic medical center. patient population: Total of 43 patients with noninfectious posterior uveitis seen by 4 investigators at the Wilmer Eye Institute. procedures: Each patient underwent standard clinical examination, followed by ultra wide-field scanning laser ophthalmoscope (SLO) imaging and angiography. Investigators successively determined disease activity and management decisions based on clinical examination, examination plus simulated 30- or 60-degree fluorescein angiography (FA) (obtained by physically narrowing the field of view of the wide-field images), examination plus ultra wide-field SLO images, and examination plus wide-field FA. main outcome measures: The primary outcome was the percentage of patients whose management changed based on the availability of wide-field imaging, compared with standard examination and imaging. The secondary outcome was detection of disease activity with and without wide-angle imaging. Management was altered in 7 of 43 patients (16%) based on examination and limited FA, whereas 21 of 43 patients (48%) had management change with the use of the ultra wide-field imaging and angiography (P < .001). Disease activity was detected in 22 of 43 patients (51%) based on examination and simulated conventional imaging, and in 27 of 43 (63%) with wide-field imaging (P = .27). The index study, with several design limitations, has suggested that ultra wide-field imaging may alter management decisions compared to standard-of-care imaging and clinical examination. Additional studies, including longitudinal evaluations, are needed to determine whether these findings, or the subsequent management alterations, may improve patient outcomes.

Peripheral Fundus Autofluorescence Is Increased in Age-Related Macular Degeneration

To evaluate peripheral fundus autofluorescence (FAF) in patients with AMD. A consecutive series of 71 normal eyes, 71 eyes with neovascular AMD having received anti-VEGF treatment, and 43 eyes with untreated AMD were investigated. In all subjects, wide-field FAF imaging was performed, applying a wide-field scanning laser ophthalmoscope. FAF was quantified by image analysis software after defining peripheral and perifoveal central measurement zones with a grid scheme; age correction was performed by regression model. Fundus autofluorescence increased with age not only in the perifoveal retinal area, but also in the retinal periphery. For age-corrected measurements, peripheral FAF was significantly increased for both, treated and untreated AMD groups compared with normal subjects. No significant difference was observed in peripheral FAF between AMD eyes having received anti-VEGF treatment and those without treatment. Age-corrected normal FAF in the retinal center differed significantly from the anti-VEGF-treated group (P < 0.01), but not the untreated AMD group. Age-corrected peripheral FAF irregularity, defined as the standard deviation in the measurement field, was significantly increased in both AMD groups compared with normal subjects. Detection of peripheral in addition to central FAF may provide additional information potentially helpful to detect and monitor the development of AMD. No differences in autofluorescence were observed in the retinal periphery between anti-VEGF-treated and untreated eyes.

Wide-Field Scanning Laser Ophthalmoscope Imaging and Angiography of Central Retinal Vein Occlusion

64-year-old man with a longstanding history of arterialhypertension underwent a diagnostic workup for adecreaseofvisioninhisrighteye.Atthetimeofpresentation,his blood pressure was treated with ramipril 2.5 mg twice perday but still was moderately increased (150/95 mm Hg,measured according to Riva Rocci [RR]). No other medica-tion was taken. Visual acuity of the right eye had decreasedfrom 20/20 to 10/100 overnight, whereas the left eye wasunaffected. Clinical examination including ophthalmos-copy suggested a retinal vein occlusion on the right eye.An Optomap wide-field scanning laser ophthalmoscope(SLO) fundus scan and wide-field angiography were per-formed for documentation and to investigate retinal perfu-sion. Optomap wide-field SLO and angiography allow retinalimages of up to 200° to be obtained without pupil dilation in1 scan. Optomap covers a much wider area of the peripheralretina than any other digital instrument for retinal imagingand has proven to be a valuable tool for screening purposes.

Screening for Diabetic Retinopathy: A Comparative Trial of Photography and Scanning Laser Ophthalmoscopy

Aims: To evaluate the sensitivity and specificity of wide-field scanning laser ophthalmoscopy (WSLO) in the detection of referable diabetic eye disease, and to compare its performance with digital retinal photography. Methods: Patients enrolled into the study underwent non-mydriatic WSLO imaging, then single- and dual-field mydriatic digital retinal photography, and examination with slit lamp biomicroscopy, the reference standard. Grading of retinopathy was performed in a masked fashion. Results: A total of 380 patients (759 eyes) were recruited to the study. Technical failure rates for dilated single-field retinal photography, dual-field retinal photography and undilated WSLO were 6.3, 5.8 and 10.8%, respectively (0.005 < p < 0.02 for photography vs. WSLO). The respective indices for screening sensitivity were 82.9, 82.9 and 83.6% (p > 0.2). Specificity was 92.1, 91.1 and 89.5%, respectively (p > 0.2). Conclusions: Sensitivity and specificity for WSLO were similar to retinal photography. The technical failure rate was greater for the WSLO used in this study.

Screening for retinal detachment using a wide field scanning laser ophthalmoscope

Abstract Purpose The development of non‐mydriatic retinal photography has changed the clinical practice, allowing detection of abnormalities in the posterior pole without clinical examination in mydriasis. However the field of view does not exceed 60° and peripheral retinal detachments are likely to be missed on these images. The purpose of this study was to evaluate a wide field (200°) imaging system (Optos, UK ) using a scanning laser ophthalmoscope (SLO) for screening purposes in retinal detachment. Methods All patients referred for retinal detachment from November 2007 to April 2008 were examined by one retinal surgeon who also performed the fundus drawing. An SLO image was taken by an orthoptist in training. A masked image lecture of the entire data base was performed by a resident. Both were unaware of the details of the retinal examination. The number of breaks and the extent of the detachment on the drawing were compared with the findings detected on the SLO image. Results 56 eyes with retinal detachment were documented. In 40 out of 56 eyes the retinal breaks could be detected on the SLO images obtained. The retinal breaks situated superiorly between 11 and 1o’clock or inferiorly between 5 and 7 o’clock and two retinal detachments, one superior and one inferior, were not detected on the SLO images. SLO image analysis enabled correct diagnosis of retinal breaks in more than 7/10 cases. Retinal detachments were detected in more than 9/10 cases. Conclusion Although the wide field SLO imaging system is not suitable as a diagnostic tool of retinal breaks and retinal detachment replacing the fundus examination by a retinal specialist, it represents a reliable screening method. Commercial interest

The Use of Ultra Wide Field Fluorescein Angiography in Evaluation and Management of Uveitis

Purpose: Uveitis can occur in all segments of the eye and has multiple etiologies, (many of which remain poorly understood). Appropriate diagnosis and subsequent management can depend on elucidation of the clinical signs. Many diagnostic features are often best identified with Fluorescein angiography. However these signs are often peripheral and visualization can be difficult with traditional angiography. Optos ultra wide field scanning laser ophthalmoscope (Optos Panoramic 200MA; Optos PLC, Dunfermline, Scotland, United Kingdom) performs ultra wide angle fluorescein angiography and its benefit in uveitis was reviewed. Design: The Jules Stein Eye Institute retina division imaging database was reviewed and five common cases were selected. Methods: The relative benefits of wide field angiography were evaluated in each of these cases. Results: Ultra wide field angiography was found to have advantages compared to traditional angiography. It allowed clear identification of peripheral signs and accurate documentation of disease progression. Conclusion: In this division ultra wide field angiography has become the investigation of choice (over traditional angiography) in cases of intermediate and posterior uveitis.

Screening diabetic retinopathy using a wide field imaging system

Abstract Purpose The wide field (200°) imaging system (Optos, Great Britain) using a scanning laser ophthalmoscope (SLO) enables to visualize a large part of the retina including the periphery. The present study was designed to evaluate the imaging system for screening purposes in diabetic retinopathy. Methods The SLO system was used in diabetic patients in stationary care. Screening for diabetic retinopathy was performed: An undilated and dilated retinal biomicroscopy was performed by a senior ophtalmologist. An undilated SLO image was taken by an orthoptist in training. The images were reviewed by a resident masked to results of the previous retinal biomicroscopy. The results of the clinical examination were compared with the results of the SLO image analysis. Results A total of 251 patients were evaluated (n=503 eyes). Of the retinal lesions detected on the undilated SLO images, the undilated retinal biomicroscopy missed 24% and the dilated retinal biomicroscopy 11%. None of the retinal lesions detected with the undilated retinal biomicroscopy were missed on the SLO images. Conclusion The diagnostic rate of diabetic retinopathy using undilated SLO images was significantly higher when compared with the diagnostic rate of undilated and dilated retinal biomicroscopy. Further work is necessary to evaluate the diagnostic yield of the wide field SLO system in comparison with standard non mydriatic retinography procedures.

Use of a wide field scanning laser ophthalmoscope for screening purposes

Abstract Purpose: The wide field (200°) imaging system (Optos, Great Britain) using a scanning laser ophthalmoscope (SLO) enables to visualize a large part of the retina including the periphery. The present study was designed to evaluate the imaging system for screening purposes. Methods: The SLO system was used in 2 groups of patients:1) Outpatient clinic:An undilated retinal biomicroscopy was performed by a resident, and an undilated SLO image was taken by an orthoptist in training. The images were reviewed by another resident masked to results of the previous retinal biomicroscopy.2) Screening for diabetic retinopathyAn undilated and dilated retinal biomicroscopy was performed by a senior ophtalmologist. An undilated SLO image was taken by an orthoptist in training. The images were reviewed by a resident masked to results of the previous retinal biomicroscopy.The results of the clinical examination were compared with the results of the SLO image analysis. Results: In the outpatient group (n=123 eyes), the undilated retinal biomicroscopy missed 18% of the retinal lesions detected on the undilated SLO images. Less than 1% of the retinal lesions detected with the undilated retinal biomicroscopy were missed on the SLO images.In the diabetes group (n=134 eyes), the undilated retinal biomicroscopy missed 10% and the dilated retinal biomicroscopy missed 5% of the retinal lesions detected on the undilated SLO images. None of the retinal lesions detected with the undilated retinal biomicroscopy were missed on the SLO images. Conclusions: In both groups of patients, the diagnostic rate of undilated SLO images was significantly higher when compared with the diagnostic rate of undilated retinal biomicroscopy.

Diagnosis and follow‐up of retinal detachment using a wide field scanning laser ophthalmoscope.

Abstract Purpose: The wide field (200°) imaging system (Optos, Great Britain) using a scanning laser ophthalmoscope (SLO) enables to visualize a large part of the retina including the periphery. The present study was designed to evaluate the imaging system for diagnostic and training purposes in retinal detachment . Methods: All patients referred for retinal detachment from November 2006 to April 2007 were examined by one retinal surgeon who also performed the fundus drawing. An SLO image was taken by an orthoptist in training and interpreted by a resident, who were both unaware of the details of the retinal examination. The number of breaks and the extent of the detachment on the drawing were compared with the findings detected on the SLO image. Results: 56 eyes with retinal detachment were documented. In 40 out of 56 eyes the retinal breaks could be detected on the SLO images obtained. The retinal breaks situated superiorly between 11 and 1 o’clock and inferiorly between 5 and 7 o’clock were missed on the SLO images. Two retinal detachments, one superior and one inferior, were missed on the SLO images. Conclusions: SLO image analysis enabled correct diagnosis of a retinal breaks and related retinal detachments in more than 7 out of 10 cases. The retinal detachment was detected on the SLO image in more than 9/10 cases. The wide field SLO imaging system is thus not suitable as a diagnostic tool of retinal detachment replacing the fundus examination, however it represents a potential tool for patient education and training of vision professionals.