Identifiable Peripheral Retinal Lesions Using Ultra-Wdefield Scanning Laser Ophthalmoscope and Its Usefulness in Myopic Patients

Dong Hyun Lee; Sung Soo Kim; Min Kim; Hyoung Jun Koh

doi:10.3341/jkos.2014.55.12.1814

Journal List > J Korean Ophthalmol Soc > v.55(12) > 1009863

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Lee, Kim, Kim, and Koh: Identifiable Peripheral Retinal Lesions Using Ultra-Wdefield Scanning Laser Ophthalmoscope and Its Usefulness in Myopic Patients

Original Article

J Korean Ophthalmol Soc 2014;55(12):1814-1820.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1814

Identifiable Peripheral Retinal Lesions Using Ultra-Wdefield Scanning Laser Ophthalmoscope and Its Usefulness in Myopic Patients

Dong Hyun Lee, MD, Sung Soo Kim, MD, PhD, Min Kim, MD, Hyoung Jun Koh, MD, PhD

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Hyoung Jun Koh, MD, PhD, Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea, Tel: 82-2-2019-3440, Fax: 82-2-3463-1049, E-mail: HJKOH@yuhs.ac

Received 28 March 2014 Revised 14 May 2014 Accepted 5 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate identifiable peripheral retinal lesions in patients with myopia or high myopia and to evaluate the usefulness of ultra-widefield scanning laser ophthalmoscope in retina clinic settings.

Methods

We evaluated fundus images of 149 patients acquired using an ultra-widefield scanning laser ophthalmoscope. Manual fundus examination by a retinal specialist was performed and sensitivity and specificity were calculated by comparing the findings of the two different fundus examination methods.

Results

Variable peripheral retinal lesions were observed: lattice degeneration (24.1% in myopia, 36.6% in high myopia), white without pressure (17.7% in myopia, 20.7% in high myopia), retinal break (5.1% in myopia, 7.5% in high myopia) and retinal detachment (1.3% in myopia, 4.2% in high myopia). The incidence of lattice degeneration was significantly higher in myopic eyes than in highly myopic eyes (p = 0.043). The examination sensitivities were as follows: lattice degeneration (84.2% in myopia, 91.0% in high myopia), white without pressure (100.0% in both myopia and high myopia), retinal break (75.0% in myopia, 43.8% in high myopia) and retinal detachment (100.0% in myopia, 66.7% in high myopia). The examination specificities were 100.0% in all cases.

Conclusions

Diagnostic sensitivities of ultra-widefield scanning laser ophthalmoscope were 90.8% in patients with myopia, 91.0% in patients with high myopia and 90.9% in totally myopic patients, which were relatively high values. Therefore, the ultra-widefield scanning laser ophthalmoscope is useful as auxiliary equipment for myopic patients in retina clinic settings.

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Keywords: High myopia, Myopia, Optomap, Peripheral retina, Scanning laser ophthalmoscope

References

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Figure 1.

Image of ultra-widefield imaging device, Optomap® Panoramic 200C (Optos PLC, Dunfermline, Fife, Scotland, UK).

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Figure 2.

Baseline age distribution of each group. 40-49 years old patients showed the highest proportion in myopic group (22.8%). 50-59-year-old patients showed the highest proportion in highly myopic group (27.7%) and in total eyes (23.3%).

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Figure 3.

An example of diagnostic failure of peripheral retinal lesions using ultra-widefield scanning laser ophthalmoscope. Nineteen-year-old male visited our clinic for known retinal detachment at the inferior quadrant of his left eye. (A) On primary gaze, ultra-widefield imaging device couldn't detect the lesion located at the inferior periphery due to eyelashes. (B) After downward gaze, a horseshoe retinal tear with bullous retinal detachment at the inferior was detected at last.

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Table 1.

Baseline characteristics of each group

	Myopia	High myopia	p-value
Eyes (n)	79	213
Age (years)	46.44 ± 20.43	45.47 ± 20.42	0.718^*
Age range (years)	26.01-66.87	25.05-65.89
Sex (M/F)	26/53	67/146	0.813^†
Laterality (OD/OS)	40/39	106/107	0.895^†
log MAR BCVA	0.38 ± 0.47	0.60 ± 0.61	0.002^*
IOP (mm Hg)	13.13 ± 4.17	13.79 ± 3.39	0.253^*
Spherical diopter (diopter)	−2.98 ± 2.05	−9.63 ± 4.19	<0.001^*
SE (diopter)	−3.12 ± 2.27	−9.82 ± 4.96	<0.001^*
AXL (mm)	24.65 ± 1.05	29.02 ± 2.15	<0.001^†

Values are presented as mean ± SD unless otherwise indicated; Using the independent samples t-test, log MAR BCVA demonstrated significant differences between myopia group and high myopia group; The eyes were divided as myopic group and highly myopic group based on spherical diopter, spherical equivalent and axial length.

log MAR = logarithm of the minimum angle of resolution; BCVA = best-corrected visual acuity; IOP = intraocular pressure; SE = spherical equivalent; AXL = axial length.

^* Independent samples t-test;

^† Mann-Whitney U-test.

Table 2.

Identified peripheral retinal lesions in patients with myopia or high myopia

	Myopia (n = 79)	High myopia (n = 213)	p-value
Barrier scar (n, %)	10 (12.7)	48 (22.5)	0.060^*
Cryotherapy scar (n, %)	0 (0.0)	1 (0.5)	1.000^†
Retinal detachment (n, %)	1 (1.3)	9 (4.2)	0.297^†
Retinal break (n, %)	4 (5.1)	16 (7.5)	0.606^†
Lattice degeneration (n, %)	19 (24.1)	78 (36.6)	0.043^*
Retinal pigmentation (n, %)	1 (1.3)	13 (6.1)	0.086^†
PVD (n, %)	26 (32.9)	86 (40.4)	0.244^*
PVR (n, %)	1 (1.3)	0 (0.0)	0.271^†
SE (n, %)	0 (0.0)	3 (1.4)	0.566^†
Vitreous opacity (n, %)	0 (0.0)	1 (0.5)	1.000^†
W s P (n, %)	14 (17.7)	44 (20.7)	0.576^*

Using either Chi-squared test or Fisher's exact test, myopia group showed significantly higher incidence of lattice degeneration than highly myopic group (p = 0.043).

PVD = posterior vitreous detachment; PVR = proliferative vitreoretinopathy; SE = scleral encircling; W s P = white without pressure.

^* Chi-squared test;

^† Fisher's exact test.

Table 3.

Detectability of peripheral retinal lesions using ultra-wide field scanning laser ophthalmoscope in patients with myopia or high myopia

	Myopia (n = 79)		High myopia (n = 213)
	Detection	Loss	Detection	Loss
Barrier scar	8	2	43	5
Cryotherapy scar	0	0	1	0
Retinal detachment	1	0	6	3
Retinal break	3	1	7	9
Lattice degeneration	16	3	71	7
Retinal pigmentation	1	0	11	2
PVD	25	1	86	0
PVR	1	0	0	0
SE	0	0	2	1
Vitreous opacity	0	0	1	0
W s P	14	0	44	0
All peripheral retinal lesions	69	7	272	27

PVD = posterior vitreous detachment; PVR = proliferative vitreoretinopathy; SE = scleral encircling; W s P = white without pressure.

Table 4.

Sensitivity and specificity of ultra-wide field scanning laser ophthalmoscope for detecting peripheral retinal lesions

	Myopia (n = 79)		High myopia (n = 213)
	Sensitivity (%)	Specificity (%)	Sensitivity (%)	Specificity (%)
Barrier scar	80.0	100.0	89.6	100.0
Cryotherapy scar	−	100.0	100.0	100.0
Retinal detachment	100.0	100.0	66.7	100.0
Retinal break	75.0	100.0	43.8	100.0
Lattice degeneration	84.2	100.0	91.0	100.0
Retinal pigmentation	100.0	100.0	84.6	100.0
PVD	96.2	100.0	100.0	100.0
PVR	100.0	100.0	−	100.0
SE	−	100.0	66.7	100.0
Vitreous opacity	−	100.0	100.0	100.0
W s P	100.0	100.0	100.0	100.0
All peripheral retinal lesions	90.8	100.0	91.0	100.0

PVD = posterior vitreous detachment; PVR = proliferative vitreoretinopathy; SE = scleral encircling; W s P = white without pressure.

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