Peripheral Lesions Identified by Mydriatic Ultrawide Field Imaging: Distribution and Potential Impact on Diabetic Retinopathy Severity

Silva, Paolo S.; Cavallerano, Jerry D.; Sun, Jennifer K.; Soliman, Ahmed Z.; Aiello, Lloyd M.

doi:10.1016/j.ophtha.2013.05.004

Cited by 254 publications

(244 citation statements)

References 24 publications

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“…In addition, peripheral lesions are identified that may suggest a more severe level of DR in 9% of eyes. This observation confirms an earlier report identifying peripheral lesions severe enough to potentially increase the severity level of DR in ;10% of eyes (14).…”

Section: Discussionsupporting

confidence: 92%

Potential Efficiency Benefits of Nonmydriatic Ultrawide Field Retinal Imaging in an Ocular Telehealth Diabetic Retinopathy Program

et al. 2013

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OBJECTIVETo compare efficiency of nonmydriatic ultrawide field retinal imaging (UWFI) and nonmydriatic fundus photography (NMFP) in a diabetic retinopathy (DR) ocular telehealth program. RESEARCH DESIGN AND METHODSPatients in this retrospective, comparative cohort study underwent NMFP and UWFI between 1 November 2011 and 1 November 2012. Images were evaluated for DR and diabetic macular edema (DME) by certified graders using a standard protocol at a centralized reading center. Identification of DR, image evaluation time, and rate of ungradable eyes were compared. RESULTSNMFP and UWFI were performed in 1,633 and 2,170 consecutive patients, respectively. No statistically significant differences were found between groups regarding age, diabetes duration, sex, ethnicity, or insulin use. The ungradable rate per patient for DR (2.9 vs. 9.9%, P < 0.0001) and DME (3.8 vs. 8.8%, P < 0.0001) was lower with UWFI than with NMFP. With UWFI, the median image evaluation time per patient was reduced from 12.8 to 9.2 min (P < 0.0001). The identification of patients with DR (38.4 vs. 33.8%) and vision-threatening DR (14.5 vs. 11.9%) was increased with UWFI versus NMFP. In a consecutive subgroup of 502 eyes of 301 patients with DR, the distribution of peripheral retinal lesions outside Early Treatment Diabetic Retinopathy Study fields suggested a more severe DR level in 9.0% (45 eyes). CONCLUSIONSIn a standardized DR ocular telehealth program, nonmydriatic UWFI reduced the ungradable rate by 71% (to <3%) and reduced image evaluation time by 28%. DR was identified 17% more frequently after UWFI, and DR peripheral lesions suggested a more severe DR level in 9%. These data suggest that UWFI may improve efficiency of ocular telehealth programs evaluating DR and DME.

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Section: Discussionsupporting

confidence: 92%

Potential Efficiency Benefits of Nonmydriatic Ultrawide Field Retinal Imaging in an Ocular Telehealth Diabetic Retinopathy Program

et al. 2013

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“…New wide-angle imaging systems using scanning laser ophthalmoscopes can visualize up to 200 degrees (82%) of the retina; this improves coverage of the mid and peripheral retina and offers improved prognostic value in diabetic reti-nopathy over conventional 7-field ETDRS photography [90,91]. Using wide-angle fluorescein angiography, correlations between peripheral retinal ischemia and diabetic macular edema have been identified [89,91], which may have therapeutic implications.…”

Section: Ocular-based Biomarkersmentioning

confidence: 99%

Biomarkers in Diabetic Retinopathy

et al. 2015

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■ AbstractThere is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat diabetic retinopathy, there is need to reliably identify and triage people with diabetes. Biomarkers may facilitate a better understanding of diabetic retinopathy, and contribute to the development of novel treatments and new clinical strategies to prevent vision loss in people with diabetes. This article reviews key aspects related to biomarker research, and focuses on some specific biomarkers relevant to diabetic retinopathy.

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“…These peripheral lesions often occur earlier in the disease course; they may also provide evidence of more advanced disease. [12][13][14] Combining UWF capabilities with ocular coherence tomography (OCT) has also been shown to have clinical utility in the assessment of DR. 15 The capabilities of UWF retinal imaging are proving particularly useful in efforts to expand screening programs for DR, particularly in teleophthalmology settings for underserved, high-risk populations.…”

Section: Ultra-widefild Imaging In Diabetic Retinopathy Detection Andmentioning

confidence: 99%

Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging

Brown¹

2017

US Ophthalmic Review

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T he incidence of diabetes in the US population has increased more than fourfold over the last several decades and a high proportion of these patients manifest diabetic eye disease, including diabetic retinopathy (DR) and diabetic macular edema (DME). Ultra-widefield (UWF) retinal imaging has emerged as a valuable tool in the evolving standard of care for DR, providing essential visualization of ischemia and related pathology across the retina, particularly in the periphery, where these signs may appear earliest but may not be detected by conventional fundus photography. Multimodal UWF imaging has helped correlate changes in the periphery with DR progression, providing important guidance for treatment planning and facilitating improved understanding of the underlying mechanisms of disease. Rapid capture, immediate retrieval and efficient sharing of UWF retinal images support a wide spectrum of care settings-including teleophthalmology programs-and facilitate patient education.

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Peripheral Lesions Identified by Mydriatic Ultrawide Field Imaging: Distribution and Potential Impact on Diabetic Retinopathy Severity

Cited by 254 publications

References 24 publications

Potential Efficiency Benefits of Nonmydriatic Ultrawide Field Retinal Imaging in an Ocular Telehealth Diabetic Retinopathy Program

Potential Efficiency Benefits of Nonmydriatic Ultrawide Field Retinal Imaging in an Ocular Telehealth Diabetic Retinopathy Program

Biomarkers in Diabetic Retinopathy

Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging

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