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Study: Imaging enhances detection of subtle retinal lesions
A study conducted by researchers at the New England College of Optometry’s New England Eye Institute has shown that image-assisted fundus examination enhances clinicians’ ability to detect retinal pathology.
The researchers sought to determine the role of nonmydriatic imaging with the Panoramic 200C Scanning Laser Ophthalmoscope (Optos, Marlborough, Mass.) as a tool for enhancing detection of retinal lesions.
In the study, 170 patients between the ages of 21 and 75 first underwent nonmydriatic Optomap imaging. Then they were dilated and underwent traditional and image-assisted fundus exam by two different examiners.
 Figure 1. This 26-year-old study subject had no symptoms and no medical or ocular history. The Optomap image shows a small retinal hemorrhage adjacent to an area of white without pressure in the peripheral retina (arrow). Image: Brown K |
Study results showed that image-assisted fundus exam can enhance detection of retinal lesions between 15% and 41% compared to traditional dilated fundus exam alone. According to Dr. Brown, the image-assisted exam detected 90.1% (118 of 131) of lesions in the posterior pole, 90.2% (101 of 112) of lesions at the optic disc and 90.5% (379 of 419) of lesions in the mid to peripheral retina compared to traditional fundus exam alone, which detected 48.8% (64 of 131) of lesions in the posterior pole, 75% (84 of 112) of lesions at the optic disc and 56.9% (238 of 419) of lesions in the mid to peripheral retina.
Kristen Brown, OD, FAAO, principal investigator of the study, presented these study results at Academy 2009 and at the Association for Research in Vision and Opthalmology annual meeting earlier this year.
Imaging more sensitive
The P200C SLO camera has an ultra-wide, 200° field of view, Dr. Brown said, which gives it a distinct advantage in providing a panoramic perspective to enhance detection of subtle retinal lesions compared to a dilated fundus exam alone. Most cameras that image the retina provide a 45° field of view.
Using the images to guide a dilated exam helps clinicians focus on specific areas of concern, Dr. Brown told Primary Care Optometry News in an interview. Review software tools are used to manipulate the image and enhance visualization of retinal features, the study authors said. The image review software enables magnification, contrast and exposure levels to be adjusted. Red and green lasers, each of which penetrates to a different layer of the retina, are used to capture the image. Viewing the red and green channels separately allows the user to highlight the retina from the choroid.
Opportunity for earlier detection
“Is important to point out that imaging does not replace dilation as standard of care,” Dr. Brown told PCON. “Image-assisted fundus exam is a great way to enhance our ability to detect retinal findings. Better and earlier detection of eye disease is good for patients and doctors alike.
“Imaging is becoming more widespread,” she continued. “In the future there might be scenearios where imaging alone is appropriate for routine evaluation of the retina, as it is with screening for diabetic retinopathy; however, further study is needed.”
Dr. Brown will be conducting a study to evaluate the sensitivity of imaging alone, as more research is needed to further assess its potential role in detection of retinal pathology, she said.
For more information:
- Kristen Brown, OD, FAAO, can be reached at the New England College of Optometry, New England Eye Institute, 930 Commonwealth Ave West, Suite 2A, Boston, MA 02215; (617) 262-2020; brownk@neco.edu. Optos provided funding for this study, but Dr. Brown has no direct financial interest in the products mentioned in this article, nor is she a paid consultant for any companies mentioned.
Reference:
- Brown K, Sewell J, Travison T. Enhancement of retinal lesion detection using P200C scanning laser ophthalmoscopy. Paper presented at: Association for Research in Vision and Ophthalmology Annual Meeting; May 3, 2010; Ft. Lauderdale, Fla.