Original article
Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis

https://doi.org/10.1016/j.ajo.2012.05.019Get rights and content

Purpose

To determine whether the use of ultra wide-field imaging changes the management or determination of disease activity in patients with noninfectious posterior uveitis.

Design

Prospective, observational case series.

Methods

setting: Divisions of Retina and Ocular Immunology at single academic medical center. patient population: Total of 43 patients with noninfectious posterior uveitis seen by 4 investigators at the Wilmer Eye Institute. procedures: Each patient underwent standard clinical examination, followed by ultra wide-field scanning laser ophthalmoscope (SLO) imaging and angiography. Investigators successively determined disease activity and management decisions based on clinical examination, examination plus simulated 30- or 60-degree fluorescein angiography (FA) (obtained by physically narrowing the field of view of the wide-field images), examination plus ultra wide-field SLO images, and examination plus wide-field FA. main outcome measures: The primary outcome was the percentage of patients whose management changed based on the availability of wide-field imaging, compared with standard examination and imaging. The secondary outcome was detection of disease activity with and without wide-angle imaging.

Results

Management was altered in 7 of 43 patients (16%) based on examination and limited FA, whereas 21 of 43 patients (48%) had management change with the use of the ultra wide-field imaging and angiography (P < .001). Disease activity was detected in 22 of 43 patients (51%) based on examination and simulated conventional imaging, and in 27 of 43 (63%) with wide-field imaging (P = .27).

Conclusions

The index study, with several design limitations, has suggested that ultra wide-field imaging may alter management decisions compared to standard-of-care imaging and clinical examination. Additional studies, including longitudinal evaluations, are needed to determine whether these findings, or the subsequent management alterations, may improve patient outcomes.

Section snippets

Methods

In this prospective, observational study of patients with noninfectious posterior uveitis, disease activity and changes in management were assessed based on clinical examination with and without simulated (30- or 60-degree) FA, and then with the addition of wide-field pseudo-color SLO images and FA using the Optos ultra-wide-field SLO (Optos Panoramic 200MA; Optos PLC, Dunfermline, Scotland, United Kingdom). New and established patients in the Divisions of Retina and Ocular Immunology at the

Results

Forty-three patients were enrolled in the index study. All patients received wide-field imaging and angiography following their clinical examination. The Table depicts the percentage of patients who demonstrated disease activity and whether management was changed based on the 4 possible combinations of examination and imaging.

Based on the clinical examination alone, the decision to alter management was made in 6 of 43 patients (14%), and in an additional 1 patient (2%) based on simulated

Discussion

Results from the index study suggest that Ultra wide-field imaging may alter management decisions compared to standard-of-care imaging and clinical examination. Such difference most likely is attributable to peripheral retinal imaging and angiographic findings not easily visualized or identified without wide-field imaging. It is intriguing that though the determination of disease “activity” did not differ with the use of wide-field imaging (when allowing for simulated conventional FA),

John Peter Campbell, MD, MPH, is currently a vitreoretinal fellow at the Casey Eye Institute, Oregon Health Sciences University. He received his doctor of medicine Alpha Omega Alpha from the Johns Hopkins University School of Medicine and master of public health from the Johns Hopkins Bloomberg School of Medicine. Dr Campbell recently completed his residency at the Wilmer Eye Institute at Johns Hopkins University, where he conducted the study with wide-angle imaging. His research interests are

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John Peter Campbell, MD, MPH, is currently a vitreoretinal fellow at the Casey Eye Institute, Oregon Health Sciences University. He received his doctor of medicine Alpha Omega Alpha from the Johns Hopkins University School of Medicine and master of public health from the Johns Hopkins Bloomberg School of Medicine. Dr Campbell recently completed his residency at the Wilmer Eye Institute at Johns Hopkins University, where he conducted the study with wide-angle imaging. His research interests are in international ophthalmology, diabetic retinopathy, and blindness prevention. At the completion of his vitreoretinal fellowship, Dr Campbell will return to Wilmer to serve as Chief Resident and Assistant Chief of Service.

Henry Alexander Leder, MD, is currently an assistant professor of ophthalmology at the Albert Einstein College of medicine. He received his bachelor of science in Physics from Yale University in 1997 and doctor of medicine from the University of Connecticut in 2002. In 2006 he completed his residency at the Louisiana State University/ Alton Ochsner Clinic Foundation program. After his residency, he went on to complete fellowship in ocular immunology and uveitis at the Wilmer Eye Institute, Johns Hopkins University followed by a medical retina fellowship at the Duke University Eye Center, and a vitreo-retinal surgery fellowship at Wilmer, where he conducted the study with wide-angle imaging. In 2008 he was appointed the first Stephen J. Ryan Assistant Chief of Service at Wilmer. At that time, he also worked for the Food and Drug administration as an ORISE consultant. Dr Leder's research interests are posterior uveitis and retinal diseases with special focus on retinal imaging, and novel medical and surgical therapies.

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