Ultra-Widefield Steering-Based Spectral-Domain Optical Coherence Tomography Imaging of the Retinal Periphery

Abstract

Objective To describe the spectral-domain optical coherence tomography (SD-OCT) features of peripheral retinal findings using an ultra-widefield (UWF) steering technique to image the retinal periphery. Design Observational study. Participants 68 patients (68 eyes) with 19 peripheral retinal features. Main Outcome Measures SD-OCT-based structural features. Methods Nineteen peripheral retinal features including: vortex vein, congenital hypertrophy of the retinal pigment epithelium (CHRPE), pars plana, ora serrata pearl, typical cystoid degeneration (TCD), cystic retinal tuft, meridional fold, lattice and cobblestone degeneration, retinal hole, retinal tear, rhegmatogenous retinal detachment (RRD), typical degenerative senile retinoschisis, peripheral laser coagulation scars, ora tooth, cryopexy scars (retinal tear and treated retinoblastoma scar), bone spicules, white without pressure, and peripheral drusen were identified by peripheral clinical examination. Near infrared (NIR) scanning laser ophthalmoscopy (SLO) images and SD-OCT of these entities were registered to UWF color photographs. Results SD-OCT resolved structural features of all peripheral findings. Dilated hyporeflective tubular structures within the choroid were observed in the vortex vein. Loss of retinal lamination, neural retinal attenuation, RPE loss or hypertrophy were seen in several entities including CHRPE, ora serrata pearl, TCD, cystic retinal tuft, meridional fold, lattice and cobblestone degenerations. Hyporeflective intraretinal spaces, indicating cystoid or schitic fluid, were seen in ora serrata pearl, ora tooth, TCD, cystic retinal tuft, meridional fold, retinal hole, and typical degenerative senile retinoschisis. The vitreoretinal interface, which often consisted of lamellae-like structures of the condensed cortical vitreous near or adherent to the neural retina, appeared clearly in most peripheral findings, confirming its association with many low-risk and vision-threatening pathologies such as lattice degeneration, meridional folds, retinal breaks, and RRDs. Conclusions UWF steering technique-based SD-OCT imaging of the retinal periphery is feasible with current commercially available devices, and provides detailed anatomical information of the peripheral retina, including benign and pathological entities, not previously imaged. This imaging technique may deepen our structural understanding of these entities, their potentially associated macular and systemic pathologies, and may influence decision-making in clinical practice, particularly in areas with teleretinal capabilities but poor access to retinal specialists.

Choroidal changes in human myopia: insights from optical coherence tomography imaging

“…It is worth noting that the majority of studies examining topographical choroidal thickness variations have examined only the macular region, which represents a relatively small percentage of the total choroidal area. However, recent developments in OCT hardware and analytical methods mean that wider areas of the choroid can now be imaged either through the montaging of multiple OCT scans, the use of a wide‐field objective lens attached to commercially available OCT devices, or with custom‐designed wide‐field OCT devices …”

Fundus autofluorescence of bilateral ora serrata pearls

“…1,2 There are only 2 reports of spectral domain OCT through OSP, and findings of schisis and retinal atrophy were described, but no evidence of actual drusen deposition was noted. 5,6 In conclusion, OSPs may be best detected with wide-field fundus autofluorescence. The bright hyperautofluorescent properties may be due to calcium phosphate.…”

Widefield Spectral-Domain Optical Coherence Tomography Imaging of Peripheral Round Retinal Holes With or Without Retinal Detachment

“…OCT imaging series suggested that there was adhesion and possible traction at these sites. 2 Similarly, Manjunath et al previously reported a 'subclinical' RD associated with a round hole with evidence of vitreous attachment on OCT scanning. 7 We planned to review SD-OCT imaging of peripheral round retinal holes, including those complicated by RD, to assess the vitreoretinal interaction.…”

“…Although OCT is predominantly used in the diagnosis and management of macular pathology, it is now possible to acquire widefield spectral domain optical coherence tomography (SD-OCT) imaging of peripheral retinal pathology, including peripheral round retinal holes. 2 Peripheral round retinal holes can be a precursor to retinal detachment (RD), and characteristics of round hole RDs have previously been described. [3][4][5] It was previously thought that there is no direct vitreoretinal traction on peripheral round retinal holes, 6…”