TY - JOUR
T1 - Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis
AU - Campbell, John Peter
AU - Leder, Henry Alexander
AU - Sepah, Yasir Jamal
AU - Gan, Theresa
AU - Dunn, James P.
AU - Hatef, Elham
AU - Cho, Brian
AU - Ibrahim, Mohamed
AU - Bittencourt, Millena
AU - Channa, Roomasa
AU - Do, Diana V.
AU - Nguyen, Quan Dong
N1 - Publisher Copyright:
© 2012 Elsevier Inc.
PY - 2012/11
Y1 - 2012/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84865279620&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84865279620&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2012.05.019
DO - 10.1016/j.ajo.2012.05.019
M3 - Article
C2 - 22935598
AN - SCOPUS:84865279620
SN - 0002-9394
VL - 154
SP - 908-911.e2
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 5
ER -