Feasibility and Clinical Utility of Ultra-Widefield–Navigated Swept-Source Optical Coherence Tomography Imaging

Abstract

Purpose: This work aims to evaluate the clinical utility and feasibility of a novel scanning laser ophthalmoscope-based navigated ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) imaging system. Methods: A retrospective, single-center, consecutive case series evaluated patients between September 2019 and October 2020 with UWF SS-OCT (modified Optos P200TxE, Optos PLC) as part of routine retinal care. The logistics of image acquisition, interpretability of images captured, nature of the peripheral abnormality, and clinical utility in management decisions were recorded. Results: Eighty-two eyes from 72 patients were included. Patients were aged 59.4 ± 17.1 years (range, 8-87 years). During imaging, 4.4 series of images were obtained in 4.1 minutes, with 86.4% of the image series deemed to be diagnostic of the peripheral pathology on blinded image review. The most common pathologic findings were chorioretinal scars (18 eyes). In 31 (38%) eyes, these images were meaningful in supporting clinical decision-making with definitive findings. Diagnoses imaged included retinal detachment combined with retinoschisis, retinal hole with overlying vitreous traction and subretinal fluid, vitreous inflammation overlying a peripheral scar, Coats disease, and peripheral retinal traction in sickle cell retinopathy. Conclusions: Navigated UWF SS-OCT imaging was clinically practical and provided high-quality characterization of peripheral retinal lesions for all eyes. Images directly contributed to management plans, including laser, injection or surgical treatment, for a clinically meaningful set of patients (38%). Future studies are needed to further assess the value of this imaging modality and its role in diagnosing, monitoring, and treating peripheral lesions.

Ultra-Widefield Swept-Source Optical Coherence Tomography Findings of Peripheral Retinal Degenerations and Breaks

“…While the overall incidence of atrophic hole and lattice-associated retinal detachment is low, these lesions are present in a disproportionate number of patients with RRD. 2,[14][15][16] Although it was not clarified in the current study, it would be great if we can know what kind of lattice degeneration, retinal tear, or retinal hole is at the high risk of developing RRD and what kind of findings are active and what kind of findings are silent with the OCT findings, which may provide useful information when a prophylactic laser for these lesions should be applied.…”

“…13 Also, the differentiation of retinoschisis from retinal detachment can be difficult to understand with an indirect ophthalmoscope alone. 2 In such cases, OCT images provide very useful information. 2 The problem of OCT imaging is that the imaging area was localized to the posterior pole of the fundus, but the field of view is expanding as the technology improves.…”

“…2 In such cases, OCT images provide very useful information. 2 The problem of OCT imaging is that the imaging area was localized to the posterior pole of the fundus, but the field of view is expanding as the technology improves.…”

“…Many important vitreoretinal abnormalities encountered in vitreoretinal care are located in the retinal periphery, identifiable on skilled peripheral retinal examination using indirect and/or direct fundus ophthalmoscopy, or more recently with the use of 2-dimensional ultra-widefield (UWF) imaging. 2,3 Previously, the imaging range of OCT was limited to the posterior pole of the fundus, but it is gradually expanding. Recently, wide angle sweptsource OCT (SSOCT) (Plex Elite 9000, Carl Zeiss Meditec, Dublin, CA) has been able to assess the midperipheral retinal structure and blood flow in various eye diseases.…”

Retinal phenotyping of variants of Alzheimer's disease using ultra‐widefield retinal images

“…The recent development of a UWF‐guided swept‐source OCT, which enables OCT imaging at any part of the retina, giving a more comprehensive analysis of the retinal periphery, 40 might help define the role of the observed high prevalence of RPD in the peripheral retina in tAD.…”