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      Ultra-widefield retinal imaging: an update on recent advances

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          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.

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          Most cited references66

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          Diabetic Retinopathy Severity and Peripheral Lesions Are Associated with Nonperfusion on Ultrawide Field Angiography.

          To assess whether the presence of peripheral nonperfusion on ultrawide field (UWF) fluorescein angiography (FA) is associated with diabetic retinopathy (DR) severity and the presence of predominantly peripheral lesions (PPLs).
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            Ultra-widefield imaging with autofluorescence and indocyanine green angiography in central serous chorioretinopathy.

            To describe the spectrum of ultra-widefield autofluorescence (AF) and indocyanine green (ICG) angiographic findings in central serous chorioretinopathy (CSC).
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              Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular oedema

              Purpose To determine the relationship between retinal ischaemia and the presence of macular oedema (DMO) in patients with diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA) imaging. Methods A retrospective review of 122 eyes of 70 treatment-naïve diabetic patients who underwent diagnostic UWFA using the Optos 200Tx imaging system. Two independent, masked graders quantified the area of retinal ischaemia. Based on clinical examination and optical coherence tomography (OCT), each patient was given a binary classification as either having DMO or no DMO. McNemar's test (with Yates' correction as indicated) and a two-sample test of proportions were used to determine the relationship between DMO and ischaemia for binary and proportional data, respectively. Linear and logistic models were constructed using generalised estimating equations to test relationships between independent variables, covariates and outcomes while controlling for inter-eye correlation, age, gender, haemoglobin A1c, mean arterial pressure and dependence on insulin. Results Seventy-six eyes (62%) exhibited areas of retinal ischaemia. There was a significant direct correlation between DMO and peripheral retinal ischaemia as seen on UWFA (p<0.001). In addition, patients with retinal ischaemia had 3.75 times increased odds of having DMO compared with those without retinal ischaemia (CI 1.26 to 11.13, p<0.02). Conclusion Retinal ischaemia is significantly correlated with DMO in treatment-naïve patients with DR. UWFA is a useful tool for detecting peripheral retinal ischaemia, which may have direct implications in the diagnosis, follow-up and treatment such as targeted peripheral photocoagulation.
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                Author and article information

                Contributors
                Journal
                Ther Adv Ophthalmol
                Ther Adv Ophthalmol
                OED
                spoed
                Therapeutic Advances in Ophthalmology
                SAGE Publications (Sage UK: London, England )
                2515-8414
                20 January 2020
                Jan-Dec 2020
                : 12
                : 2515841419899495
                Affiliations
                [1-2515841419899495]Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
                [2-2515841419899495]Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
                [3-2515841419899495]Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
                [4-2515841419899495]Assistant Professor of Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107, USA
                Author notes
                Author information
                https://orcid.org/0000-0002-3050-9129
                Article
                10.1177_2515841419899495
                10.1177/2515841419899495
                6971964
                34bac7d0-ff31-4978-9ce5-d93a6d45818b
                © The Author(s), 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 29 September 2019
                : 10 December 2019
                Categories
                Review
                Custom metadata
                January-December 2020
                ts1

                diabetic retinopathy,telemedicine,ultra-widefield imaging,widefield imaging

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