Update on wide- and ultra-widefield retinal imaging

Abstract

The peripheral retina is the site of pathology in many ocular diseases and ultra-widefield (UWF) imaging is one of the new technologies available to ophthalmologists to manage some of these diseases. Currently, there are several imaging systems used in practice for the purpose of diagnostic, monitoring disease progression or response to therapy, and telemedicine. These include modalities for both adults and pediatric patients. The current systems are capable of producing wide- and UWF color fundus photographs, fluorescein and indocyanine green angiograms, and autofluorescence images. Using this technology, important clinical observations have been made in diseases such as diabetic retinopathy, uveitides, retinal vascular occlusions and tumors, intraocular tumors, retinopathy of prematurity, and age-related macular degeneration. Widefield imaging offers excellent postoperative documentation of retinal detachment surgery. New applications will soon be available to integrate this technology into large volume routine clinical practice.

Figure 1

A mosaic fundus photo of the right eye of a 42-year-old female with advanced retinitis pigmentosa showing waxy pallor of the optic nerve head, attenuated retinal blood vessels, numerous bone spicule-like formations approaching the vascular arcades. White arrow points to a blood vessel shadow, an artifact during image alignment

Figure 2

(a) A widefield fundus image of the right eye of a 3-month-old infant with dysplastic optic nerve head, intraretinal, and vitreous hemorrhages (RetCam, Pleasanton, CA, USA), (b) fluorescein angiography of the same eye as in a taken with the same imaging system showing retinal blood vessels filling, blockage from intraretinal hemorrhage (white arrowhead) and staining (white arrow)

Figure 3

A widefield infrared image of the left eye of a 46-year-old man with macular coloboma of unknown origin. An image taken with noncontact lens (Heidelberg Engineering, Heidelberg, Germany) showing peripapillary atrophy, thin retinal blood vessels, and a well-defined choroidal vasculature

Figure 4

(a) An ultra-widefield color fundus photo of the right eye of a 36-year-old patient with a history of pars planitis in both eyes. The image was taken with an ultra-wide imaging system (Optos 200Tx, Dunfermline, UK). Dark shadows in the central field represent vitreous opacities. There is a sclerotic retinal vessel in the nasal periphery (white arrow) in the area of prior inflammation, (b) an ultra-widefield fluorescein angiogram of the same eye as in a showing central vitreous opacities and staining of the peripheral retinal vessel (white arrowhead)

Figure 5

An ultra-widefield color fundus photo of an eye with proliferative diabetic retinopathy taken with slit-lamp and three-dimensional CCD camera. Inverted image shows preretinal hemorrhage inferiorly and scattered laser photocoagulation burns

Figure 6

An ultra-widefield color fundus photo of the left eye with high myopia taken with slit-lamp and three-dimensional CCD camera. Inverted image shows rarefaction of the retinal pigment epithelium and patches of chorioretinal atrophy in the posterior pole

Figure 7

An ultra-widefield fluorescein angiogram of the left eye of a 54-year-old diabetic patient. The images show leakage in the macular area, peripheral areas of nonperfusion, and neovascularization nasally

Figure 8

An ultra-widefield fluorescein angiogram of the eyes of a 34-year-old patient with a history of chronic Vogt–Koyanagi–Harada syndrome. The images of right eye (left panel) and left eye (right panel) show disturbance and hyperfluorescence of the retinal pigment epithelium

Figure 9

An ultra-widefield color fundus photo of the left eye of a 60-year-old patient with central retinal vein occlusion. The image shows intraretinal hemorrhages in all retinal quadrants

Figure 10

An ultra-widefield color fundus photo of the right eye of a 13-year-old male with Coat's disease showing both peripheral and central retinal involvement. Laser photocoagulation was applied to ablate telangiectatic retinal vessels, which led to reduction in exudation

Figure 11

An ultra-widefield color fundus photo of the right eye of a 37-year-old patient with rhegmatogenous retinal detachment. There is inferior retinal detachment with large breaks in the inferotemporal periphery (white arrow)