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Purpose Susac's syndrome (ScS) is a rare, potentially life-threatening auto-immune disease. Ophthalmic imaging can depict characteristic branch retinal arteriolar occlusions (BRAO) and arterial wall hyperfluorescences that form one of the three diagnostic pillars of this condition. We aim to demonstrate that ophthalmological ultrawide-field (UWF) imaging allows for a qualitative and quantitative assessment in ScS, with application in diagnostics, monitoring of treatment response, and titration of therapy. Methods In seven ScS patients (♀:♂ = 2:5), with a median age of 36 years, range 18 to 57 years, serial ultrawide-field fluoresceine angiography (UWF-FA) studies were performed, with adjunctive wide-field optical coherence tomography angiography analyses (WF-OCTA) in five patients. Mean follow-up was 12.5 months, range 1 to 46 months. Results In all seven patients, branch retinal arteriolar occlusions (BRAO) and arterial wall hyperfluorescences were present in UWF-FA and calculated as a quantitative score of disease activity in fluorescein angiography (DA-FA) during follow-up visits. Treatment response was accessible in follow-up imaging as partial reperfusion of retinal vessels, resolution of arterial wall hyperfluorescences and consequently, in reduction of DA-FA score. While qualitative analysis of WF-OCTA provided further information about retinal micro-perfusion, quantitative analysis did not demonstrate a vectored treatment response as it was accessible in FA. Conclusion DA-FA score, as a comprehensive disease activity parameter in ScS has potential to facilitate optimal communication between subspecialties and thereby treatment success.

To investigate the detection of lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field fundus imaging system (Optos) with convolutional neural network technology. This study included 1500 Optos color images for tessellated fundus confirmation and peripheral retinal lesion (lattice degeneration, retinal breaks, and retinal detachment) assessment. Three retinal specialists evaluated all images and proposed the reference standard when an agreement was achieved. Then, 722 images were used to train and verify a combined deep-learning system of 3 optimal binary classification models trained using seResNext50 algorithm with 2 preprocessing methods (original resizing and cropping), and a test set of 189 images were applied to verify the performance compared to the reference standard. With optimal preprocessing approach (original resizing method for lattice degeneration and retinal detachment, cropping method for retinal breaks), the combined deep-learning system exhibited an area under curve of 0.888, 0.953, and 1.000 for detection of lattice degeneration, retinal breaks, and retinal detachment respectively in tessellated eyes. The referral accuracy of this system was 79.8% compared to the reference standard. A deep-learning system is feasible to detect lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field images. And this system may be considered for screening and telemedicine.

Purpose: Diabetic retinopathy (DR) is the leading cause of blindness among working-aged adults aged 20 to 74 years. Despite professional association guidelines that recommend yearly screening for DR, only about 60% of Americans with diabetes mellitus (DM) receive annual examinations. The purpose of this 2-phase study was to determine the ability of family medicine (FM) physicians to accurately interpret retinal images of patients with DM. Methods: Five FM physicians received a 1-hour lecture on DR by a retinal specialist after which the physicians were shown 30 ultrawide-field retina images and asked to determine whether the images contained signs of DR (phase 1). Patients: Patients with DM who had not received an eye examination within the past year underwent nonmydriatic retinal photography in a FM clinic (phase 2). The 5 FM physicians were asked to evaluate the images for signs of DR and the images were simultaneously sent to a retinal specialist for independent interpretation. The diagnoses of the FM physicians and retina specialist were compared. Patients were informed of their results and were asked to complete a brief telephone survey regarding their experience with the screening process. Results: Thirty retina images, 5 with DR and 25 without DR, were included in the postlecture assessment. Each of the 30 images was reviewed by all 5 FM physicians. Of the 5 images with DR, 3 were correctly diagnosed by all 5 FM physicians, 1 was correctly diagnosed by 4, and 1 was accurately diagnosed by 3. Overall accuracy for the 5 FM physicians was 100%, 100%, 100%, 97%, and 87%. Among the 34 patients included in phase 2, 3 (8%) were diagnosed with DR by the retinal specialist but 8 (24%) were diagnosed with DR by the FM physicians. Of the 3 patients with DR confirmed by the retinal specialist, only 1 was detected by the FM physicians (sensitivity, 33%; 95% CI, 1% to 91%). Of the 31 patients without DR as determined by the retinal specialist, 24 were accurately diagnosed by the FM physicians (specificity, 77%; 95% CI, 59% to 90%). The screening procedure was considered easy/efficient by 28 of 31 (90%) respondents. Conclusion: To improve early detection of DR new screening methods should be considered. FM physicians were able to accurately identify DR on postlecture images but were not as accurate when evaluating images taken from patients in the FM clinic. Patients found the screening process to be easy and efficient. This study was limited by the small sample size, particularly the limited number of DR cases. Future studies that include cases with a wide variation of DR severity are needed to determine the accuracy of FM physicians at detecting DR in a clinical setting.

AIM: To evaluate the fractal feature of the retinal vasculature of normal eyes on a stereographic projected and montaged ultra-wide field (UWF) fluorescein angiography (FA). METHODS: Prospective, observational, cross-sectional study. Totally 59 eyes of 31 normal subjects were imaged using the Optos 200Tx. Images obtained at different gaze angles stereographically projected and montaged. The early-phase UWF FA frames were processed to segment the retinal vasculature and the results were exported as binary masks. The fractal dimension (FD) was calculated using the box-counting method. RESULTS: The global FD for the entire retina was 1.6±0.04, with no difference between males and females (1.59±0.04 vs 1.61±0.04, P=0.084) or between right and left eyes (1.6±0.04 vs 1.6±0.05, P=0.61). FD was non-uniformly distributed among four quadrants (P0.05). CONCLUSION: Fractal geometry is non-uniformly distributed across the retina in normal eyes and decreases from the fovea to the far-periphery. Subjects with an older age tend to have a smaller FD, however, the FD in the far-periphery does not appear to be influenced by age.

BACKGROUND: Diagnosis of small choroidal melanoma is mainly based on tumour thickness, subretinal fluid, or lipofuscin pigment. Ultra-wide-field imaging (UWF) allows depiction of choroidal lesions through a red (RC) and a green channel (GC). Aim of the study was to determine the utility of this tool in the detection of small choroidal melanoma. METHODS: Retrospective cross-sectional study of patients with small choroidal pigmented lesions up to 3 mm in thickness. All patients underwent clinical and imaging assessment including UWF. Lesions were subcategorized based on thickness and lesion type. A qualitative assessment ensued using the red and green channels feature. RESULTS: A total of 152 patients were included. Melanotic naevi (76/152,50%) and small choroidal melanomas (55/152,36%) were the predominant types. Thickness was

Ultra–wide-field imaging and ultra–wide-field intravenous fundus fluorescein angiography using Optos 200Tx reveal the characteristics of retinopathy of prematurity at different stages, which have the potential to screen, diagnose, and follow-up for retinopathy of prematurity., Purpose: To determine the feasibility of ultra–wide-field imaging and ultra–wide-field intravenous fundus fluorescein angiography (UWF-IV-FFA) in infants with retinopathy of prematurity (ROP) using Optos 200Tx. Methods: We performed Optos 200Tx capturing on 32 premature infants (14 females) and UWF-IV-FFA with Optos 200Tx on 12 of the 32 infants between April 2017 and July 2018 at the affiliated eye hospital of Wenzhou Medical University and analyzed their fundus images. Results: Ultra–wide-field color images were acquired from 32 infants (64 eyes). UWF-IV-FFA was performed successfully in 12 premature infants (24 eyes). No adverse events were observed. The ultra–wide-field Optos 200Tx color images and UWF-IV-FFA images revealed Stages 1, 2, and 3 ROP and aggressive posterior ROP. Conclusion: Ultra–wide-field imaging and intravenous fundus fluorescein angiography using Optos 200Tx are feasible in infants with ROP, which have the potential to screen, diagnose, and follow-up for ROP.

To quantify changes of the retinal vascular bed area (RVBA) in mm2 on stereographically projected ultrawide field fluorescein angiography images in eyes with proliferative diabetic retinopathy after antivascular endothelial growth factor injection.This is a prospective, observational study. The early-phase ultrawide field fluorescein angiography images (Optos 200Tx) of 40 eyes with proliferative diabetic retinopathy and significant nonperfusion obtained at baseline and after six months (NCT02863354) were stereographically projected by correcting peripheral distortion. The global retinal vasculature on ultrawide field fluorescein angiography was extracted for calculating RVBA by summing the real size (mm2) of all the pixels automatically.For the entire cohort, the global RVBA for the entire retina decreased from 67.1 ± 15.5 to 43.6 ± 18.8 mm2 after anti-VEGF treatment at six months (P0.001). In the subgroup receiving monthly anti-VEGF injections, the global RVBA decreased from 68.7 ± 16.2 to 33.9 ± 13.3 mm2 (P0.001). In the subgroup receiving anti-VEGF every three months, the global RVBA decreased from 65.6 ± 15.1 to 50.8 ± 19.3 mm2 (P = 0.004).RVBA seems to be a new biomarker to indicate efficiency of retinal vascular changes after anti-VEGF injection. Eyes with proliferative diabetic retinopathy and significant nonperfusion demonstrate reduced RVBA after anti-VEGF treatment.

To analyze the distribution of diabetic retinopathy (DR) lesions in an Indian population using ultra-wide field (UWF) fundus imaging. Seven hundred fifteen subjects (1406 eyes) with diabetic retinopathy in India were enrolled in this multicenter, prospective, observational study using UWF pseudocolor imaging with Optos Daytona Plus (Optos plc, Dunfermline, Scotland, UK). Images were transmitted to Doheny Image Reading Center, Los Angeles, CA, for grading. The ETDRS grid was overlaid on stereographic projections of UWF images, and images were graded independently by 2 masked graders. Lesion distribution was graded as predominantly central (PCL) or predominantly peripheral (PPL) according to previous criteria, considering both lesion number and area. An image was graded as PPL if > 50% of the lesion area was seen in at least one peripheral field as compared with the corresponding ETDRS field. Diabetic retinopathy severity was also assessed based on the International Classification of Diabetic Retinopathy (ICDR) grading scale. The main outcome measures were lesion distribution (PPL versus PCL): overall and within specific fields in eyes with various grades of DR. Lesion distribution was rated to be PPL in 37% of eyes and PCL in 63% of eyes (P

Ultra-wide-field (UWF) imaging has been used clinically in retina practices for nearly two decades to achieve rapid, single-frame photographic access to the mid- and far-retinal periphery.1–5 These...

Visual-angle has been used as the conventional unit to determine the field-of-view (FOV) in traditional fundus photography. Recently emerging usage of eye-angle as the unit in wide field fundus photography creates confusion about FOV interpretation in instrumentation design and clinical application. This study aims to systematically derive the relationship between the visual-angle θv and eye-angle θe, and thus to enable reliable determination of the FOV in wide field fundus photography. FOV conversion ratio θe/θv, angular conversion ratio Δθe/Δθv, retinal conversion ratio Δd/Δθv, retinal distance and area are quantitatively evaluated. Systematic analysis indicates that reliable conversion between the θv and θe requires determined nodal point and spherical radius of the eye; and the conversion ratio is not linear from the central field to peripheral region. Based on the eye model with average parameters, both angular conversion (Δθe/Δθv) and retinal conversion (Δd/Δθv) ratios are observed to have a 1.51-fold difference at the central field and far peripheral region. A conversion table, including θe/θv, Δθe/Δθv, Δd/Δθv, retinal area and percentage ratio, is created for reliable assessment of imaging systems with variable FOV.

Purpose. The present study aimed to compare the accuracy of diabetic retinopathy (DR) staging with a deep convolutional neural network (DCNN) using two different types of fundus cameras and composite images. Method. The study included 491 ultra-wide-field fundus ophthalmoscopy and optical coherence tomography angiography (OCTA) images that passed an image-quality review and were graded as no apparent DR (NDR; 169 images), mild nonproliferative DR (NPDR; 76 images), moderate NPDR (54 images), severe NPDR (90 images), and proliferative DR (PDR; 102 images) by three retinal experts by the International Clinical Diabetic Retinopathy Severity Scale. The findings of tests 1 and 2 to identify no apparent diabetic retinopathy (NDR) and PDR, respectively, were then assessed. For each verification, Optos, OCTA, and Optos OCTA imaging scans with DCNN were performed. Result. The Optos, OCTA, and Optos OCTA imaging test results for comparison between NDR and DR showed mean areas under the curve (AUC) of 0.79, 0.883, and 0.847; sensitivity rates of 80.9%, 83.9%, and 78.6%; and specificity rates of 55%, 71.6%, and 69.8%, respectively. Meanwhile, the Optos, OCTA, and Optos OCTA imaging test results for comparison between NDR and PDR showed mean AUC of 0.981, 0.928, and 0.964; sensitivity rates of 90.2%, 74.5%, and 80.4%; and specificity rates of 97%, 97%, and 96.4%, respectively. Conclusion. The combination of Optos and OCTA imaging with DCNN could detect DR at desirable levels of accuracy and may be useful in clinical practice and retinal screening. Although the combination of multiple imaging techniques might overcome their individual weaknesses and provide comprehensive imaging, artificial intelligence in classifying multimodal images has not always produced accurate results.

Purpose: To describe the eyes with vitreous floaters and to analyze the development of acute symptomatic posterior vitreous detachment (PVD). Methods: A retrospective review of medical records was performed on patients with the vitreous floater developed for the first time of their life. Peripapillary vitreous opacity (pVO) was searched in Ultra-wide field (UWF) scanning laser ophthalmoscopy and PVD stage was assessed through spectral-domain optical coherence tomography (SD-OCT). Results: 196 patients (55 males and 141 females), who were 58.4(±9.1) on years old, visited a retinal clinic 9.4 (±9.1) days after they experienced vitreous floaters. (pVO) was noticed in 62.2% at UWF and PVD was initiated more than 94.3%. Symptomatic eyes had more prevalence of peripapillary vitreous opacity (63.2% vs 18.4%, p=0.040) and more advance staged PVD (pConclusion: In patients with first floater symptoms, PVD was in progress in most of the eyes not only the symptomatic eyes but also on the contralateral symptom free eyes. Eyes with vitreous floaters were more myopic and had lower IOP than the opposite symptom free eyes.

Background: Ophthalmological screening for cytomegalovirus retinitis (CMVR) for HIV/AIDS patients is important. The application of a deep learning (DL) system to AIDS-related CMVR with ultra-wide-field (UWF) fundus images is promising, but the feasibility and efficiency of this method have not been studied. Methods: We independently developed and internally validated a DL system for identifying active CMVR, inactive CMVR and non-CMVR in 6960 UWF fundus images from 862 AIDS patients and validated the system in a prospective and an external validation data set using area under curve (AUC), accuracy, sensitivity, and specificity. A heat map identified the most important area (lesions) used by the DL system for differentiating CMVR. This trial is registered with ClinicalTrials.gov, number NCT04831333. Findings The DL system showed AUCs of 0·945 (95% confidence interval [CI]: 0·929, 0·962), 0·964 (95% CI: 0·870, 0·999) and 0·968 (95% CI: 0·860, 1·000) for detecting active CMVR from non-CMVR and 0·923 (95% CI: 0·908, 0·938), 0·902 (0·857, 0·948) and 0·884 (0·851, 0·917) for detecting active CMVR from non-CMVR in the internal cross-validation, external validation, and prospective validation, respectively. It also showed the ability to differentiate active CMVR from non-CMVR and inactive CMVR as well as to identify active CMVR and inactive CMVR from non-CMVR (all AUCs in the three independent data sets >0·900). The heat maps successfully highlighted lesion locations. Interpretation: Our system showed reliable performance for detecting AIDS-rated CMVR. DL technology is promising for screening and differentiating CMVR in AIDS patients. Clinical Trial: This trial is registered with ClinicalTrials.gov, number NCT04831333. Funding: Scientific Research Project of Beijing Youan Hospital, CCMU, 2018 (YNKTQN20180201); Capital Health Research and Development of Special (2020-1-2052); Science & Technology Project of Beijing Municipal Science & Technology Commission (Z181100001818003); Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20150201). Declaration of Interest: The authors have no conflicts of interest to declare. Ethical Approval: This study was conducted in accordance with the Declaration of Helsinki. Both the Ethics Committee of Beijing YouAn Hospital (LL-2018-150-K) and the Ethics Committee of Beijing Tongren Hospital (TRECKY2018-056) approved the study. Written informed consent was obtained from each subject.

Visually impaired and blind people due to diabetic retinopathy were 2.6 million in 2015 and estimated to be 3.2 million in 2020 globally. Though the incidence of diabetic retinopathy is expected to decrease for high-income countries, detection and treatment of it in the early stages are crucial for low-income and middle-income countries. Due to the recent advancement of deep learning technologies, researchers showed that automated screening and grading of diabetic retinopathy are efficient in saving time and workforce. However, most automatic systems utilize conventional fundus photography, despite ultra-wide-field fundus photography provides up to 82% of the retinal surface. In this study, we present a diabetic retinopathy detection system based on ultra-wide-field fundus photography and deep learning. In experiments, we show that the use of early treatment diabetic retinopathy study 7-standard field image extracted from ultra-wide-field fundus photography outperforms that of the optic disc and macula centered image in a statistical sense.

Purpose The purpose of this study is to compare the lesion detection rates of ocular toxocariasis (OT) between ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and conventional fundus photography (CFP), and to evaluate the potential diagnostic ability of UWF-SLO in OT. Methods A total of 56 patients with serological/immunological confirmed unilateral OT were enrolled. The presence of OT characteristic features included the posterior granuloma (postG), peripheral granuloma (periG), tractional retinal detachment (TRD), retinal folds (RF), and vitreous strands (VS) and was analyzed in 36 patients with UWF-SLO and 56 patients with CFP. Diagnostic tests were employed using the clinical examination as gold standard. Results In total of the 56 OT eyes, granulomas were identified in 91.1% (51/56) of eyes, including postG in 46.4% (26/56) of eyes, periG in 41.1% (23/56) of eyes, and combined granulomas in 3.6% (2/56) of eyes. TRD, RF, and VS were found in 28.6% (16/56), 51.8% (29/56), and 83.9% (47/56) of patients, respectively. Although the specificities of the diagnosis in clinical features were similar by the diagnostic tests, the sensitivities of postG, periG, TRD, RF, and VS using UWF-SLO were 100%, 100%, 66.7%, 95%, and 81.8%, respectively, which were significantly higher those of CFP (72.2%, 31.3%, 11.1%, 55%, and 48.5%). Additionally, the extent of vitreous haze was milder graded by UWF-SLO compared to CFP (p = 0.0099). Conclusions The diagnostic ability of UWF-SLO was superior to CFP using clinical examination as gold standard for the ascertainment of the characteristic manifestations of OT, especially for granulomas and RF.

Purpose The appearance of the far peripheral retina in normal eyes was observed using an Optos ultra-wide field fluorescein angiography imaging system. Methods A cross-sectional study of ultra-wide field pseudocolor and angiography images obtained using the Optos 200Tx. Four different non-vascular and six vascular-associated fluorescence features in far peripheral retina were analyzed. Results A total of 166 eyes in 83 patients met the inclusion criteria. The mean patient age was 40.78 ± 10.94 years (range: 20–65 years) with a female-to-male ratio of 0.98. Slight cataract were present in 64 eyes (38.55%), low to moderate myopia in 50 eyes (30.12%), and unspecified visual disturbances in 52 eyes (31.33%). Far peripheral retinas were found to have mottled florescent band in 42.17% eyes, ground glass hyperfluorescence in 84.34% eyes, granular hyperfluorescence in 12.65% eyes, local mottled fluorescence in 10.84% eyes, vascular anastomosis with a peripheral avascular area in 36.23% eyes, invisible capillary details in 50.67% eyes, vessels passing through the ora serrata in 16.98% eyes, late-phase slight leakage in 32.53% eyes, angiectasis in 18.67% eyes, and microaneurysm in 34.94% eyes. Conclusion Ultra-wide field fluorescein angiography revealed various fluorescence features in the periphery of normal eyes, providing a basis for interpreting normal and pathological changes in peripheral retina and an important reference for clinical work.

Purpose: To explore the potential use of ultra-wide-field (UWF) imaging for screening of cytomegalovirus retinitis (CMVR) in AIDS patients. Methods: Ninety-four patients whose CD4 count was below 200 cells/μL were enrolled in a prospective study. Each patient underwent UWF imaging and indirect ophthalmoscopy. The main outcome measures were the concordance and detection rates of these 2 approaches and the sensitivity and specificity of UWF imaging. Results: Twenty-seven eyes in 18 patients were diagnosed with CMVR by the indirect ophthalmoscopy. UWF imaging missed the diagnosis in 1 eye because of a zone 3 CMVR lesion. The UWF image showed several CMVR patterns and locations: hemorrhagic necrotizing lesion, granular lesion, frosted branch angiitis, and optic neuropathy lesion. The concordance of the 2 approaches was excellent for the diagnosis of CMVR, classification of CMVR pattern, and location of CMVR. The detection rates of UWF imaging and indirect ophthalmoscopy were 14.0% (26/186; 95% CI 0.089–0.190) and 14.5% (27/186; 95% CI 0.094–0.196), respectively (p = 1.000). The sensitivity and specificity of UWF imaging were 96.3 and 100%, respectively. Conclusions: UWF imaging is capable of documentation of different CMVR lesions and AIDS-related CMVR screening when examination by an ophthalmologist is not available.

Aim: To evaluate patterns of retinal vasculitis with ultra-wide field imaging (UWF) and ascertain the risk factors for retinal neovascularization. Methods: Consecutive patients of retinal vasculitis were included prospectively. Patients with retinal vasculitis secondary to uveitis were excluded. UWF was done for all the patients. Retinal involvement was classified into three zones and area of capillary non-perfusion was stratified into clock hours. Results: Two hundred patients were included, 85% (n = 170) were male. Mean age was 28.99 ± 10.56 years. Clinical examination revealed 65% cases (n = 130) to be bilateral, while UWF angiography detected 72.5% (n = 145) to have bilateral involvement. Retinal neovascularization was present in 47% (n = 188).Presence of posterior disease had very high odds ratio for development of retinal neovascularization as compared to cases restricted to retinal periphery (OR = 45.03, CI = 6.10-332.30, p = < 0.001). Conclusion: UWF imaging is useful in detecting retinal vasculitis, which is otherwise obscure to clinical examination and assessing risk factors for retinal neovascularization.

Objective: To describe the ultra-wide field imaging features of pigmented para-venous retino-choroidal atrophy. Design: Retrospective review at a tertiary care centre. Participants: Eight eyes of five patients with pigmented para-venous retino-choroidal atrophy who presented to our retina clinic over last 2 years. Methods: Retrospective review of ultra-wide field pseudo-colour and short wave autofluorescence imaging was performed. In vivo histology of the macula and areas of retino-choroidal atrophy was studied with swept source optical coherence tomography (SS-OCT). Results: The median age was 40 years (range: 22–67 years). Best corrected visual acuity ranged from perception of light to 20/20. The para-venous retino-choroidal atrophy and pigment clumping not only involved the major arcade vessels but also extended into the peripapillary area and retinal periphery. The affected areas demonstrated hypoautofluorescence with sharp hyperautofluorescent borders. Macular atrophy, epiretinal membrane and optic disc pallor were noted in two eyes each. In all cases, the affected pigmentary area had disorganization of inner retinal layers, disruption of outer retinal layers and retinal pigment epithelium and markedly thinned out choroid on swept source optical coherence tomography. Concurrent involvement with retinitis pigmentosa in the fellow eye was noted in two patients. Conclusion: Ultra-wide field imaging of pigmented para-venous retino-choroidal atrophy sheds light onto the widespread retino-choroidal abnormalities. Concurrent disc and macular involvement may jeopardize the visual function. Pigmented para-venous retino-choroidal atrophy may be considered as a self-limited form of retinitis pigmentosa.

Background/aimsTo investigate the prevalence of abnormal central and peripheral ultra-wide-field (UWF) angiography findings, and their association with clinical features in acute Vogt-Koyanagi-Harada (VKH) disease.MethodsThis retrospective, observational study included 26 eyes of 13 treatment-naïve patients with acute VKH disease who underwent UWF fluorescein angiography (FA). Sixteen eyes of eight patients also underwent UWF indocyanine green angiography (ICGA). A circle simulating the central 75° field was used to divide the acquired image into the central fundus area (CFA) and peripheral fundus area (PFA), in which the presence of six previously reported abnormal angiographic findings were analysed. Correlations between abnormal angiography findings in FA and clinical features were also investigated.ResultsAll eyes demonstrated more than one abnormal angiographic finding in both the CFA and PFA. UWF FA revealed three abnormal findings in the CFA versus the PFA: focal leakage (92.3% vs 76.9%); pooling with a dark rim (84.6% vs 53.8%); and retinal vascular leakage (0% vs 46.2%). UWF ICGA revealed three abnormal findings in the CFA versus the PFA: hypofluorescent dark dots (100% vs 100%); diffusely leaking fuzzy choroidal vessels (93.8% vs 75.0%); and late hypofluorescent patches (81.3% vs 31.3%). Pooling with a dark rim and retinal vascular leakage in the PFA were significantly associated with low initial visual acuity (p=0.03) and subfoveal choroidal thickness change ratio (p=0.04), respectively.ConclusionAbnormal UWF angiography findings were frequently detected in the CFA and PFA. Such findings may be useful in evaluation and monitoring of VKH disease.

To compare the ability of wide-angle optical coherence tomography angiography (OCTA) with that of ultra-wide field fluorescein angiography (UWFFA) to detect non-perfusion areas (NPAs) or retinal neovascularization (NV) in eyes with diabetic retinopathy (DR). Patients with DR underwent UWFFA using the Optos® panoramic 200Tx imaging system and wide-angle OCTA with 12 × 12 mm fields of five visual fixations using the PLEX Elite 9000®. We compared the abilities of UWFFA and OCTA to detect NPAs and NV. Fifty-eight eyes of 33 patients (mean age, 60.0 years old; female/male, 16/17) with DR were evaluated. NPAs were detected in 47 out of 58 eyes using UWFFA and in 48 eyes using OCTA. NVs were detected in 25 out of the 58 eyes using UWFFA and in 26 eyes using OCTA. The sensitivity for detection of NPA using OCTA was 0.98, and the specificity was 0.82. The sensitivity for detection of NV was 1.0, and the specificity was 0.97. The wide-angle OCTA seems to be clinically useful for the detection of NPAs or NV.

Fundus digital photography and optical coherence tomography (OCT) are currently the primary imaging approaches for early diagnosis and treatment of eye diseases. In recent years, the significant development in artificial intelligence (AI), particularly in machine learning (ML) and deep learning (DL) are new and vital technical-driven motivations impacting on the traditional diagnosis and treatment methods. At the same time, the ultra-wide field (UWF) imaging technology is getting widely accepted and prevalent by its obvious advantageous features of non-dilate pupils, express-track result and the vast pool of fundus viewing angles. As a result, numerous research have been done to explore AI in ultra-wide field fundus imaging ophthalmology for joint diagnosis and treatment. However, the current review of this method is still in least ink. We first outlines the application and impact of AI technology in ophthalmic diseases in the past ten years. With the following part exclusively summarizing the technical integration of ultra-wide field fundus images and AI technology in the past four years, which has brought innovations to clinical treatment methods for the diagnosis and treatment of ophthalmic diseases; finally, we analyzed the application and implementation of the novel technology as well as the potential limitations and challenges, to predict the possibility of the technology’s further principles role and values in clinical ophthalmology.

Peripheral retinal imaging is a unique approach for assessing and monitoring ocular diseases. In this paper, we proposed a design for an optical coherence tomography system to accomplish ultrawide field (&gt, 120°) retinal imaging without montages. Scanning of the sample arm was achieved via two ellipsoidal mirrors. The optical design software Zemax and an eye model were used to estimate the inherent aberrations in the system and the optical performance of retinal imaging. Simulation results of the aberrations in the designed system indicated that the designed system can achieve an unprecedented imaging field of view (FOV) while maintaining acceptable resolution without sacrificing the working distance. This work suggests that ultrawide field optical coherence tomography retinal imaging is achievable, which is highly important for the diagnosis and treatment of ocular—especially peripheral—retinopathy.

Purpose: To analyze the clinical features and long-term prognosis of uveitis in tubulointerstitial nephritis and uveitis (TINU) syndrome in a cohort of Chinese patients. Methods: A total of 32 patients with TINU syndrome between 2000 - 2016 were analyzed retrospectively. Results: Mild anterior inflammation was observed in all cases. Ultra-wide-field fluorescence angiography (UWFA) was conducted on 13 patients, and peripheral vascular leakage was observed in 22/26 eyes (84.62%) compared with active anterior chamber inflammation in 13/26 eyes (50%). Three patients received increased corticosteroid dosage therapy on their first episode of uveitis guided by UWFA had stopped steroids without recurrence. Conclusion: The uveitis in TINU syndrome was mild. Corticosteroids were efficient in most cases, but a slower tapering and long-term treatment were required. UWFA is sensitive in detecting the activity of uveitis and might be useful in monitoring disease progression. Complete withdrawal of medication was difficult to achieve in some cases.

Introduction: Widefield and ultra-widefield (uwf) retinal imaging of diabetic retinopathy can provide information outside that obtained by standard retinal imaging and has the potential to improve the clinical management of diabetic retinopathy.Areas covered: The evidence for clinical benefit of ultra-widefield imaging has been reviewed and put into context in relation to other retinal imaging systems. A medline search was performed using the relevant key words. Several variants of the term ‘ultra widefield’ were searched in relation to diabetic retinopathy imaging as no standard term has been used over time.Expert commentary: Uwf colour and fluorescein angiography combined with optical coherence tomography images, read by a reading centre, provide the most accurate way of assessing the retina. Widefield optical coherence tomography angiography is also becoming available. The use of these technologies can provide better screening, referral refinement, more efficient and accurate clinic assessments...

Since 1991, 7-field images captured with 30-50 degree cameras in the Early Treatment Diabetic Retinopathy Study were the gold standard for fundus imaging to study diabetic retinopathy. Ultra-wide-field images cover significantly more area (up to 82%) of the fundus and with ocular steering can in many cases image 100% of the fundus ("panretinal"). Recent advances in image analysis of ultra-wide-field imaging allow for precise measurements of the peripheral retinal lesions. There is a growing consensus in the literature that ultra-wide-field imaging improves detection of peripheral lesions in diabetic retinopathy and leads to more accurate classification of the disease. There is discordance among studies, however, on the correlation between peripheral diabetic lesions and diabetic macular edema and optimal management strategies to treat diabetic retinopathy.

Rhegmatogenous retinal detachment (RRD) is a serious condition that can lead to blindness; however, it is highly treatable with timely and appropriate treatment. Thus, early diagnosis and treatment of RRD is crucial. In this study, we applied deep learning, a machine-learning technology, to detect RRD using ultra–wide-field fundus images and investigated its performance. In total, 411 images (329 for training and 82 for grading) from 407 RRD patients and 420 images (336 for training and 84 for grading) from 238 non-RRD patients were used in this study. The deep learning model demonstrated a high sensitivity of 97.6% [95% confidence interval (CI), 94.2–100%] and a high specificity of 96.5% (95% CI, 90.2–100%), and the area under the curve was 0.988 (95% CI, 0.981–0.995). This model can improve medical care in remote areas where eye clinics are not available by using ultra–wide-field fundus ophthalmoscopy for the accurate diagnosis of RRD. Early diagnosis of RRD can prevent blindness.

Alessandro Rabiolo,1 Mariacristina Parravano,2 Lea Querques,1,2 Maria Vittoria Cicinelli,1 Adriano Carnevali,1,3 Riccardo Sacconi,1,4 Teresa Centoducati,1 Stela Vujosevic,5 Francesco Bandello,1 Giuseppe Querques1 1Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, 2G. B. Bietti Foundation – IRCCS, Rome, 3Department of Ophthalmology, University of “Magna Graecia,” Catanzaro, 4Department of Neurological and Movement Sciences, University of Verona, Verona, 5Department of Neuroscience, Ophthalmology Clinic, University of Padova, Padova, Italy Abstract: Fluorescein angiography (FA) is a useful examination in patients suffering from diabetic retinopathy (DR). Traditional angiograms explore 30°–50° of the retina at once; however, visualization of peripheral retina is fundamental in order to assess nonperfused areas, vascular leakage, microvascular abnormalities, and neovascularizations. In order to expand the field of view, wide-field and ultra-wide-field imaging has been developed allowing to image up to 200° of retinal surface in one single shot. The aim of this narrative review was to provide an overview of the role of the most recent technique of ultra-wide-field fluorescein angiography in DR. Keywords: ischemic index, targeted retinal photocoagulation, diabetic macular edema, diabetic macular ischemia, peripheral vessel leakage, capillary nonperfusion

Objective:To evaluate the imaging characteristics of choroidal melanoma before and after proton beam radiotherapy via Optos®ultra-wide-field scanning laser ophthalmoscopy.Methods:Retrospective, descriptive study of choroidal melanoma patients treated with proton beam radiotherapy. All patients underwent full clinical evaluation, including best-corrected visual acuity, ultrasound examination and ultra-wide-field scanning laser ophthalmoscopy imaging in the pseudo-colour (red and green channel) as well as auto-fluorescence mode. Tumours were classified and evaluated according to their location, size, presence of subretinal fluid, drusen, orange pigment and reflectance intensity in ultra-wide-field scanning laser ophthalmoscopy. Tumour sonographic (basal diameter, height) and ultra-wide-field scanning laser ophthalmoscopy imaging dimensions (maximal diameter) were documented.Results:A total of 39 eyes (38 patients) were followed for 24 months (range 6–48 months). Mean best-corrected visual acuity dropped from 20/40 to 20/63 after proton beam radiotherapy. There was no change in the imaging tumour characteristics during follow-up. Subretinal fluid changes were better detected in the autofluorescence compared to pseudo-colour mode. Mean tumour diameter did not significantly change in the ultra-wide-field scanning laser ophthalmoscopy although it did so in the ultrasound. No patient showed local tumour recurrence.Conclusion:The ultra-wide-field scanning laser ophthalmoscopy imaging characteristics of choroidal melanoma in the Optos®system do not significantly change after proton beam radiotherapy after a mean follow-up of 2 years.

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/2076-3425/10/8/521 Background: to compare the extent of the detached retina and retinal tears location in rhegmatogenous retinal detachment (RRD) among non-mydriatic ultra-wide field (UWF) imaging, dilated fundus exam (DFE), and intraoperative evaluation. Methods: this retrospective chart review comprised 123 patients undergoing surgery for RRD. A masked retina specialist analyzed the UWF fundus images for RRD area, status of the macula, and presence and location of retinal breaks. The same variables were collected from a database including DFE and intraoperative recordings. Evaluation methods were compared. Results: mean age was 59.8 14.9 years. Best-corrected visual acuity improved from 0.25 0.3 (Snellen) to 0.67 0.3 at 12 months (p = 0.009). The RRD description and assessment of macula status (34.5% macula-on) did not di er between UWF, DFE, and intraoperative examination. The inferior quadrant was involved most frequently (41.5%), followed by the superior (38.9%), temporal (27.8%) and nasal quadrant (14.8%). Intraoperative exam detected 96.7% of retinal tears compared with DFE (73.2%, p = 0.008) and UWF imaging (65%, p=0.003). UWF imaging and DFE did not di er significantly. Conclusion: RRD extent on DFE and UWF images was consistent with intraoperative findings. UWF and DFE detection of peripheral retinal tears was similar, but 25% of retinal breaks were missed until intraoperative evaluation.

Ultra-wide field OCT (UWF-OCT) is a useful instrument for the detection and classification of posterior staphylomas. Morphological features of posterior staphylomas shown by UWF-OCT are gradual thinning of the choroid from the periphery toward the edge of the staphyloma and a gradual re-thickening of the choroid in the direction toward the posterior pole along with a posterior displacement of the sclera in the staphylomatous area. Also, there is a gradual thickening and inward protrusion of the sclera at the staphyloma edge. UWF-OCT will be a standard instrument for the detection of posterior staphylomas.

Purpose: To determine if non-mydriatic ultra wide-angle digital retinal imaging alone is effective for screening subjects considered to be at 50% or lower risk for developing retinal angiom...

Background: To observe the retinal lesions in HIV/AIDS patients and to evaluate the consistency of non-mydriatic ultra-wide-field (UWF) retinal imaging and mydriatic slit lamp biomicroscope with Superfield lens. Methods: 193 eyes of 98 consecutive HIV/AIDS patients were enrolled. The retinal lesions in each patients were observed through UWF fundus imaging and slit lamp biomicroscopic with Superfield lens whose consistency was analyzed. Results: 100 eyes (51.8%） had fundus lesions, 20 eyes (20%) presented posterior microvascular retinopathy (MVR), 19 eyes (19%) presented peripheral MVR, 15 eyes (15%) presented early stage cytomegalovirus retinitis (CMVR), 6 eyes showed initial stage CMVR, and 51 eyes showed other changes (papilledema, etc.). The consistency of two methods was moderate in detecting the isolated peripheral lesions (Kappa = 0.445) or HIV-related MVR (Kappa = 0.513), and high in inspecting the posterior/posterior involved lesions (Kappa = 0.831) or CMVR (Kappa = 1.0). The detection rate of UWF retinal imaging and slit lamp biomicroscopic were 15.5%（30/193）and 17.6%（34/193）(P=0.557＞0.05) for HIV-related MVR, 7.8% (15/193) (P=1.000＞0.05) for CMVR, 37.3% (72/193) and 33.7% (65/193) (P=0.118＞0.05) for posterior/posterior involved lesions, 8.8% (17/193) and 17.6% (34/193) (P=0.001＜0.05) for isolated peripheral lesions , respectively. Conclusions: The HIV-related MVR can be posterior or peripheral. Various fundus changes appear in HIV/AIDS patients, not only MVR or CMVR. The non-mydriatic UWF fundus imaging system and mydriatic slit lamp biomicroscope exhibited good consistency and nondiscriminatory detection rate for CMVR, HIV-related MVR and posterior lesions, but not for isolated peripheral lesions.

AimsTo quantify retinal vascular bed area (RVBA) in square millimetres on stereographically projected ultra-wide field (UWF) fluorescein angiography (FA) in eyes with diabetic retinopathy (DR).MethodsA prospective, observational study. Baseline Optos 200Tx UWF FA images of 80 eyes with DR from the DAVE (NCT01552408) and RECOVERY (NCT02863354) studies were stereographically projected at the Doheny Image Reading Center to adjust for peripheral distortion. The early-phase FA frame was used to extract the retinal vasculature as a mask for calculating RVBA. The pixels of the retinal vasculature were automatically computed in square millimetres using manufacturer-provided software.ResultsEighteen of 80 diabetic eyes were excluded because image quality and contrast were insufficient for automatic extraction of the retinal vasculature from the background fluorescence. The remaining 62 eyes were included in the final analysis. In comparison with age-matched and sex-matched normal controls, eyes with DR had a higher global RVBA for the entire retina (p2) than in those with non-proliferative DR (56.2±16.6 mm2) or in normal controls (37.2±9.9 mm2). This tendency was also present in the posterior retina and mid-periphery but absent in the far-periphery. RVBA did not correlate with retinal ischaemia (p>0.05).ConclusionsEyes with DR harboured a larger global RVBA for the entire retina than normal controls, and RVBA appeared to indicate DR severity. However, this biomarker was not observed to be a good indicator of retinal ischaemia.

Background The conventional fundus imaging covers up to 60 degrees of retina only. Although various montaging techniques can significantly increase the area that can be imaged, it is still difficult to image and document the peripheral retina. The purpose of this study is to describe the use of ultra-wide field imaging in the diagnosis and management of adult-onset Coats’ disease. Methods This is a retrospective case series of three patients diagnosed with adult-onset Coats’ disease that were treated at the retina clinic of our institute. The case records, conventional and ultra-wide field fluorescein angiograms and optical coherence tomography scans were reviewed. Results The ultra-wide field pseudo-colour photographs and fluorescein angiograms were able to provide clinically useful information over and above that provided by conventional imaging. In all three patients, ultra-wide field angiography showed the temporal avascular periphery. In addition, it revealed retinal neovascularisation, peripheral vascular leakage and documented peripheral telangiectasia in selected patients. Conclusion Ultra-wide field imaging provides information that can help in the diagnosis and management of adult-onset Coat's disease. This may lead to better visual outcomes in Coats’ disease.

This study aims to investigate the ability of the ultra-wide-field scanning laser ophthalmoscope (UWF SLO) in clinically detecting and evaluating asymptomatic early-stage familial exudative vitreoretinopathy (FEVR). We retrospectively reviewed 163 eyes of 83 asymptomatic family members of 48 patients with FEVR. UWF SLO imaging (Optos® PLC, Scotland, UK) was performed on asymptomatic family members as a preliminary screening test for fundus anomalies, and the findings were compared with subsequent examinations using indirect fundus ophthalmoscopy in full mydriasis, fluorescein angiography (FA), fundus autoflourescence, and genetic sequencing. A total of 86 eyes of 43 asymptomatic family members were clinically diagnosed with early-stage FEVR, and 17 of the affected 43 family members were also genetically diagnosed. Compared with FA as a standard, the UWF SLO was highly effective in diagnosing FEVR with a sensitivity and specificity of 93.0 % and 97.5 %, respectively. The UWF SLO was able to diagnose early-stage FEVR in 93.0 % of eyes, and guided the selection of therapies in 46.5 % of the eyes studied. UWF SLO is a valuable imaging tool for detecting fundus anomalies related to early-stage FEVR, and this tool can assist in the clinical diagnosis and evaluation of early-stage FEVR in asymptomatic family members of patients with FEVR.

Purpose To present an overview on ultra-wide-field imaging in diabetic retinopathy. Methods A comprehensive search of the pubmed database was performed using the search terms of “ultra-wide-field imaging”, “ultra-wide-field fluorescein angiography” and “diabetic retinopathy”. The relevant original articles were reviewed. Results New advances in ultra-wide-field imaging allow for precise measurements of the peripheral retinal lesions. A consistent finding amongst these articles was that ultra-wide-field imaging improved detection of peripheral lesion. There was discordance among the studies, however, on the correlation between peripheral diabetic lesions and diabetic macular edema. Conclusions Visualization of the peripheral retina using ultra-wide-field imaging improves diagnosis and classification of diabetic retinopathy. Additional studies are needed to better define the association of peripheral diabetic lesions with diabetic macular edema.

This study examined whether age and brachial-ankle pulse-wave velocity (baPWV) can be predicted with ultra-wide-field pseudo-color (UWPC) images using deep learning (DL). We examined 170 UWPC images of both eyes of 85 participants (40 men and 45 women, mean age: 57.5 ± 20.9 years). Three types of images were included (total, central, and peripheral) and analyzed by k-fold cross-validation (k = 5) using Visual Geometry Group-16. After bias was eliminated using the generalized linear mixed model, the standard regression coefficients (SRCs) between actual age and baPWV and predicted age and baPWV from the UWPC images by the neural network were calculated, and the prediction accuracies of the DL model for age and baPWV were examined. The SRC between actual age and predicted age by the neural network was 0.833 for all images, 0.818 for central images, and 0.649 for peripheral images (all P P