More Effective Screening for Epiretinal Membranes With Multicolor Scanning Laser Ophthalmoscope Than With Color Fundus Photographs

Abstract

Purpose: To assess the ability of the multicolor scanning laser ophthalmoscope (MC-SLO) to screen for epiretinal membranes (ERMs). Methods: A retrospective cross-sectional study of 35 eyes of 32 patients with an ERM detected by optical coherence tomography and 46 eyes of 23 healthy volunteers. The detection of the ERM was graded into three visibility scores—1, not visible, 2, barely visible, and 3, clearly visible—by retina specialists or by ophthalmology residents. The sensitivity and specificity of the detection with the merged image of the MC-SLO or color fundus photographs (CFPs) were calculated. Results: The sensitivity for ERM detection in the MC-SLO and CFP were 91.4% and 65.7% by specialists and 97.1% and 60.0% by residents. The specificity for both devices was 100% by specialists and residents. The visibility score for the MC-SLO images were significantly higher than that for the CFP by both specialists and residents. In addition, the visibility score for the MC-SLO determined by residents was significantly higher than that for the CFP by specialists. Conclusion: The detection of an ERM is better with the MC-SLO images than with CFP. Furthermore, the ERM detection in the MC-SLO images by residents was comparable to that by specialists.

Recent Advances and Clinical Application of Color Scanning Laser Ophthalmoscope

“…Most of the studies using color SLO have reported higher rates of detection of retinal abnormalities compared to conventional color fundus photographs. In addition, there are also reports of clinical contributions by enabling the making of a correct diagnosis by nonspecialists [17] and improving surgical performances [22]. Recently, there has been a lot of research on artificial intelligence (AI) using fundus photographs, OCT, and OCT angiography images [36][37][38][39][40], and there is a highly likelihood that color SLO, which has high image quality with a large amount of information, will be useful for this kind of automatic diagnosis by AI.…”

“…Importantly, each wavelength produces a distinctive image of the different layers of the retina [13]. The width of a scan is about 10 μm but varies with the model [17]. This is about the same as the 6 × 6 mm scan of recent Optical coherence tomography (OCT) devices, making it possible to record changes in a small area.…”

“…Furthermore, some reports have investigated how it is applied in clinical ophthalmology. For example, the authors found that epiretinal membrane (ERM) findings were not only clearly displayed in the color SLO images, but also that medical residents were able to determine ERM findings with high detection rates similar to that of retinal specialists [17]. In addition, Zhang et al reported that they were able to shorten the time for ERM peeling and improve the outcomes by simulating the surgery using color SLO before the actual surgery [22].…”

“…An ERM is another relatively common disorder that can be clearly seen in color SLO images even though the ERM is not visible in the conventional fundus photographs [17,18]. Although color SLO images tend to focus on color images composed of images of a single wavelength, our study found that the fibrotic membranes of ERMs were more visible in short wavelength images in green and blue, which provided greater contrast with the background (Figure 7) [17]. On the other hand, the retinal fold component was more prominent in the red wavelength SLO images and also in the combined color images.…”

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

“…When a wide eld color image is recorded, the original single blue, green, and red SLO images are obtained simultaneously. In the multicolor SLO, the appearance of the lesion is different for each color image because the penetration of the different colors of laser is different 18,19 .…”