Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients

Abstract

PurposeTo compare mydriatic and eye-steering ultrawide field imaging (UWFI) with standard non-mydriatic UWFI examination in detecting peripheral retinal lesions in myopic patients.MethodsCross-sectional, observational study. 220 eyes of 110 myopic patients with known peripheral retinal lesions in at least one eye under Goldmann three mirror contact lens examination were recruited. Non-mydriatic standard and eye-steering UWFI images were taken centrally and with eye-steering technique in upper, lower, nasal and temporal gazes under Optomap UWFI (Daytona, Optos, UK). Mydriatic standard and eye-steering UWFI was captured in central gaze and four different peripheral gazes. Sensitivity of detecting peripheral retinal lesions under different UWFI settings was compared.Results141 (64.09%) eyes were with peripheral retinal lesions. The sensitivity for detecting peripheral lesions from low to high was 41.84% (95% CI 33.62% to 50.54%) under non-mydriatic standard UWFI setting, 52.48% (95% CI 44.08% to 60.75%) under mydriatic standard setting, 75.18% (95% CI 67.21% to 82.06%) under non-mydriatic eye-steering setting and 86.52% (95% CI 79.76% to 91.69%) under mydriatic eye-steering setting. Both mydriasis and eye-steering technique increased sensitivity of detecting peripheral lesions with statistical significance (p<0.001). By applying eye-steering technique, sensitivity of detecting lesions located in superior and inferior quadrants witnessed a greater increase compared with other two quadrants (p<0.05). Neither spherical equivalence (p>0.05) nor axial length (p>0.05) was an independent influence factor for detecting peripheral lesions.ConclusionsEye-steering technique and mydriasis could both efficiently improve the sensitivity of detecting peripheral retinal lesions in myopic patients. Lesions of superior and inferior quadrants benefited more from eye-steering technique.

Combined application of B-scan ultrasonography and eye-steering ultrawide field imaging to improve the detection of retinal tears before cataract surgery

“…Previously, the effect of AL on detecting retinal tears remained controversial. 11,20,28,29 In our study, B-scan US performed well in highly myopic subgroup perhaps because of the higher rate of horseshoe tears (40%) in this AL subgroup, whereas UWFI performed better than B-scan US in extreme myopic subgroup, probably because extreme long eyes have more complicated abnormalities of vitreoretinal interface, 30 thus interfering with the observation of retinal tears by B-scan US. The good performance of UWFI in extreme long eyes may be also related to the higher percentage of atrophic holes (50%), which are more easily detected by UWFI in this group.…”

“…Unlike the B-scan US, UWFI directly provides a retinogram of more than 80% of the retinal surface and relies little on the proficiency of technicians, acting as a reliable diagnostic method for various kinds of retinopathy. 17,18 It can achieve the sensitivity up to 86.5% to 89.2% for retinal lesions among noncataractous eyes, 11,19 expected to be a convenient tool for fast screening. In cataractous eyes, UWFI tends to show better penetrability than indirect ophthalmoscopy according to the clinical experience from doctors, although poor media transparency may affect image resolution.…”

“…Retinal tears were classified into four types: horseshoe tears (H), atrophic holes (A), operculated tears (O), and giant tears (G). Fundus was divided into four quadrants according to previous studies 11 : superior (S; 10:30–1:30 clock hours), inferior (I; 4:30–7:30), temporal (T; 7:30–10:30 for right eyes; 1:30–4:30 for left eyes), and nasal (N; 1:30–4:30 for right eyes; 7:30–10:30 for left eyes) quadrants.…”

“…In recent years, ultrawide field imaging (UWFI) has emerged to be a widely used method to detect peripheral retinal lesions with a large scan angle of up to 200°, short time, and high resolution. [9][10][11] The clinical experience of doctors even indicates that UWFI sometimes shows better penetrability than indirect ophthalmoscopy in the presence of cataracts. Therefore, it is very necessary to figure out whether combined application of B-scan US and UW-FI would perform better in detecting retinal tears before cataract surgery.…”

Cataract surgery in myopic eyes

“…The use of ultrawide field imaging preoperatively may be helpful to detect peripheral retinal lesions. A study by Li et al [11 ] has demonstrated that the sensitivity of mydriatic eye steering ultrawide field imaging for detecting peripheral retinal lesions in myopic eyes was 86.52% compared with 41.48% with nonmydriatic standard imaging. There is no consensus whether prophylactic laser photocoagulation should be performed for asymptomatic retinal lesions prior to surgery [12].…”