Use of the Optomap with lid retraction and its sensitivity and specificity#

Abstract

Background:Optomap uses the ultra-wide field scanning laser ophthalmoscopy to provide retinal examination. It permits fundus examination without the use of a mydriatic, which is more comfortable for the patients. This paper determines the sensitivity and specificity of the Optomap for detecting retinal signs under non-mydriatic conditions. Methods: Fifty-four eyes identified with retinal/choroidal signs and eight normal eyes were recruited from 31 Hong Kong Chinese subjects. Photo-documentation of fundal changes was obtained with the Optomap under non-mydriatic conditions before a dilated fundus examination by a clinician using standard procedures. The eyelid was retracted using a cotton bud when necessary. Dilated fundus examinations were performed by another clinician using binocular indirect ophthalmoscopy and slitlamp biomicroscopy with a fundus lens. The Optomap images were evaluated by four other investigators under masked condition. The International Classification of Disease, Ninth Revision (ICD-9-CM) was adopted for recording retinal features. Screening results were compared with those obtained using the dilated fundus examination as the gold standard. Results: The cotton bud method for eyelid retraction showed an improvement in the area of retina that could be visualised. The sensitivity and specificity of the Optomap averaged 76.4 and 71.9 per cent, respectively. Some fundal signs were missed by all observers in the Optomap but not with the biomicroscope. These included white-without-pressure, lattice degeneration, paramacular drusen and pigmentary changes at central fundus. Conclusion: Optomap serves as a reliable screening tool for fundus examination especially because it covers a much wider area of the peripheral retina than other digital instruments for fundus photography.

Clinical Utility of Ultra-Widefield Imaging with the Optos Optomap Compared with Indirect Ophthalmoscopy in the Setting of Non-Traumatic Rhegmatogenous Retinal Detachment

“…2,10,11,14,15 Inoue et al found that use of an eyelid speculum helped prevent obstruction by eyelashes and allowed a fuller view of the retina, 16 and Cheng et al found that eyelid retraction using a cotton bud proved useful. 17 Proper positioning of the patient's view can also affect peripheral imaging. In our clinic, technicians who obtained the UWF photos tended to position the eye so that the retinal detachments were most visible, which on occasion was detrimental to the ability to detect pathology in other quadrants.…”

Agreement between image grading of conventional (45°) and ultra wide-angle (200°) digital images in the macula in the Reykjavik eye study

“…[13][14][15][16] Ultra wide-angle images had not previously been used to grade changes associated with ARM or AMD, although the presence of pathological abnormalities in the macula had been described. 17 In this study, we …”

Comparison of image-assisted versus traditional fundus examination

“…Recent studies have found nonmydriatic digital retinal imaging with UWF SLO to be a reliable screening tool for diabetic retinopathy and choroidal lesions. [24][25][26][27][28] Silva et al found excellent agreement between nonmydriatic Optomap UWF SLO images, Early Treatment Diabetic Retinopathy Study (ETDRS) photographs, and dilated ophthalmoscopy. 29 To our knowledge, this is the first study to evaluate the ability of nonmydriatic imaging to enhance a dilated fundus examination in the detection of retinal pathology, diabetic or otherwise.…”