Ultra-widefield retinal imaging: an update on recent advances

Abstract

The development of ultra-widefield retinal imaging has accelerated our understanding of common retinal diseases. As we continue to validate the diagnostic and prognostic significance of pathology in the retinal periphery, the ability to visualize and evaluate these features in an efficient and patient-friendly manner will become more important. Current interest in ultra-widefield imaging includes the development of potential biomarkers of disease progression and indicators of preclinical disease development. This article reviews the current ultra-widefield imaging systems and recent advances in their applications to clinical practice with a focus on diabetic retinopathy, retinal vein occlusion, uveitis, and pediatric retina.

Keywords: diabetic retinopathy; telemedicine; ultra-widefield imaging; widefield imaging.

Figure 1.

Proliferative diabetic retinopathy: (a) Optos color fundus SLO of left eye shows advanced treatment naïve PDR with tractional retinal detachment involving the macula and (b) UWF-FA shows significant peripheral nonperfusion and severe, posterior, and mid-peripheral retinal neovascularization.

Figure 2.

Branched retinal vein occlusion: (a) Optos color fundus SLO of the right eye displays an inferior BRVO that may not have been detected on standard non-widefield imaging. (b) and (c) UWF-FA shows significant peripheral retinal nonperfusion with retinal neovascularization inferotemporally.

Figure 3.

Vogt–Koyanagi–Harada disease: (a) Optos color fundus SLO displays multifocal bacillary serous retinal detachments in the posterior pole. (b) UWF-FAF shows mottled hyperautofluoresence consistent with the multifocal serous retinal detachments. (c) UWF-FA shows early blocking and late staining of the multifocal serous detachments. (d) UWF-ICGA with early hypocyanescence from the multifocal serous detachments with mild late hyperpermeability of medium-sized choroidal vessels.

Figure 4.

Retinopathy of prematurity: RetCam color fundus photographs of the left eye showing a nasal (a), posterior pole (b), and temporal (c) views of an infant diagnosed with zone II, Stage 2, Type 2 ROP.

Figure 5.

Sickle cell retinopathy: (a) Optos color fundus SLO of right eye with patient with sickle cell disease appears normal without hemorrhage or peripheral sclerotic vessels. (b) UWF-FA reveals superonasal nonperfusion with early retinal neovascularization that would not otherwise be detected on standard 50°–75° non-widefield FA.