Fundus exam necessary to detect horseshoe tears
Click Here to Manage Email Alerts
Key takeaways:
- Nearly half of horseshoe tears were not visualized on ultra-widefield imaging.
- The sensitivity of ultra-widefield imaging was lowest in the superior quadrant.
Ultra-widefield imaging alone is not sufficient for detecting retinal horseshoe tears and should not replace funduscopic examination, according to a study published in the American Journal of Ophthalmology.
Although use of ultra-widefield (UWF) imaging has grown considerably, the technology remains limited by cost, availability of skilled photographers, artifacts and lack of true color representation, as well as often poor visualization of inferior and superior sectors, researchers wrote.
They added: “The preferred method for evaluating peripheral vitreoretinal diseases, including [retinal tears], involves funduscopic evaluation via scleral depressed examination.”
To test the sensitivity of UWF imaging in detecting retinal horseshoe tears (HSTs), researchers performed a retrospective analysis on 123 patients (mean age, 57.3 years; 52% men) with HSTs at the Shiley Eye Institute at University of California, San Diego. Eligible individuals were diagnosed by an ophthalmologist or vitreoretinal specialist via scleral depressed examination and underwent treatment with laser retinopexy.
The researchers determined that 51.1% of HSTs were visualized on UWF images, while 48.9% were not. Notably, the sensitivity of UWF imaging was 17.1% in the superior quadrant, 32% in the inferior quadrant, 50% in the nasal quadrant and 85.5% in the temporal quadrant.
“Considering the urgency of treating HSTs and the potential for significant visual morbidity from [retinal detachments], it is crucial to highlight that UWF imaging should not be relied upon as a substitute for funduscopic examination in the evaluation of [posterior vitreous detachment] or symptoms indicative of an HST,” researchers wrote. “This cautionary note is essential, as a negative UWF image can provide false reassurance, potentially leading to delayed diagnosis and management of a critical retinal condition.”
Perspective
Back to Top
The role of UWF imaging as an adjunct to dilated fundus evaluation in documentation and evaluation of peripheral and posterior retinal pathology in clinical practice has been well-supported, as have the technology’s limitations. Even in optimal circumstances, the entire retina cannot be captured with current imaging strategies, which introduces a gap between the potential presence of pathology and that which is detectable by UWF imaging.
The presented study supports the necessity of clinical examination for the detection of peripheral horseshoe retinal tears even in the presence of unremarkable UWF imaging, with the lowest sensitivity for detection of pathology by UWF imaging for inferior and superior horseshoe tears. The study results reflect my personal experience where an asymptomatic inferior retinal break in my own eye detected by clinical examination was not able to be imaged using UWF technology, despite image steering.
A clear understanding of a technology’s intended use in addition to understanding its limitations allows us to best incorporate and optimize new technology in clinical practice to improve patient outcomes.
Collapse
Read more about
Click Here to Manage Email Alerts