Wide field and ultra wide field image evaluation in diabetic retinopathy: Definition and reasons for to be present instead of future

Abreu-González, R.; Fernández-Vigo, J.I.; Donate-López, J.

doi:10.1016/j.oftale.2022.03.009

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Abreu-González, J.I. Fernández-Vigo, J. Donate-López" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Abreu-González" "email" => array:1 [ 0 => "rodrigoabreug@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." 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A: 163° UWF colour fundus photograph (Mirante®, Nidek®, Gamagori, Japan); B: 12 × mm12 OCT-A (Cirrus®, Carl Zeiss Meditec®, Jena, Germany); C: 23 mm UWF OCT (Silverstone®, Optos®, Dunfermline, UK)." ] ] ] "textoCompleto" => "Lately, Wide Field (WF) and Ultra Wide Field (UWF) imaging is strongly emerging as an option in multimodal retinal diagnostic imaging, both in retinography and in optical coherence tomography (OCT) and angiography using OCT (OCT-A),<a class="elsevierStyleCrossRef" href="#bib0005">1</a> although it is true that wide field contrast angiography has been the first modality to be incorporated into our daily practice.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This is considered especially useful for retinal pathologies with an important component of peripheral retinal involvement and high prevalence, such as diabetic retinopathy.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Conventional 30−50° colour retinography appeared last century, while structural OCT celebrates its 30th anniversary this year and OCT-A is still far from a decade old. The WF version of the 3 diagnostic imaging modalities in retina and UWF for retinography and OCT are now commercially available, which is leading to an increasing number of publications and communications, and is currently one of the topics that attracts most interest at congresses due to its relevance in clinical practice.The current gold standard for the classification of diabetic retinopathy is the Early Treatment Diabetic Retinopathy Study (ETDRS)<a class="elsevierStyleCrossRef" href="#bib0020">4</a> scale, which is based on 7-field retinography and has the following limitations: it has limited accuracy, it may be insufficient for the assessment of the peripheral effect of new intravitreal treatments against vascular endothelial growth factor and most clinicians do not use it due to its complexity. Accordingly, tthe most widely used classification is the International Diabetic Retinopathy Severity Scale.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Before considering their implementation in our daily clinical practice, the first we need to know is the clear and precise definition of WF and UWF for the 3 imaging modalities and then evaluate the advantages and disadvantages of their use in the management of patients with diabetic retinopathy:DefinitionFor both retinography and OCT, UWF is considered if the image reaches the area anterior to the exit of the vortical veins of the retina and WF if the image only reaches the area of the retina between the posterior pole (24 × 24 mm centred on the fovea) and anterior to the vortices.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> However for OCT-A, due to current technological development, WF is defined if the image is greater than 70° centred in fovea and UWF if greater than 90° centred in fovea (an assembly of 2 images of 15 × 9 mm). For the definition of the location of the structural OCT B-scan slice we used the following concepts: mid periphery (60−100°) and far periphery (110−220°)<a class="elsevierStyleCrossRef" href="#bib0035">7</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Advantages of WF and UWF assessmentWith the WF and UWF image we can assess the central and peripheral retina of the diabetic patient and, above all, define whether our patient has predominantly central or peripheral diabetic retinopathy (hemorrhages and microaneurysms, intraretinal vascular anomalies or neovessels located 60% outside the ETDRS fields), as in 10% of cases peripheral lesions indicate a more severe degree of diabetic retinopathy than when assessed with the ETDRS classification alone.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> By having all the information in a single image, the fundus of a diabetic patient could be seen better and faster, and funduscopy could probably become dispensable.With the new OCT systems, both WF and UWF OCT-A allow us to better define and quantify vascular lesions and areas of ischemia when compared to conventional fluorescein angiography<a class="elsevierStyleCrossRef" href="#bib0045">9</a> and even characterise the pattern and density of individual retinal vascular plexuses.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> OCT, with WF and UWF images, also provides important information for planning treatment with focal laser photocoagulation or assessing the overall effect on diffuse edema after intravitreal treatment.DisadvantagesThe main disadvantage is the monetary cost since, in most cases, we would be forced to incorporate new imaging equipment, with higher prices than current retinography or OCT systems and much higher than the price of a standard 45° colour retinograph and the consequent readjustment of workflows, since we would require ancillary equipment to carry out these tests, which require time for their acquisition.There is a small learning curve in capturing and interpreting WF and UWF images, as they are not new image modalities, but the same as those we use now with a much larger capture area.Based on the above, and the technological evolution and improvement that WF and UWF equipment has undergone in recent times, both for retinography, OCT and OCT-A, there is no doubt that these types of retinal imaging systems are already a great advance that is allowing us to be more efficient and make less invasive and more accurate diagnoses for our patients with diabetes, whether or not they have already developed diabetic retinopathy, which will lead to health outcomes that will not take long to be observed and have a great impact on the health of our society. Therefore, in our opinion, the advantages offered by WF and UWF imaging in diabetic retinopathy justify its progressive implementation in daily clinical practice.FundingThis work has not received any funding.Conflict of interestNo conflicts of interest were declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Definition" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Advantages of WF and UWF assessment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Disadvantages" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Abreu-González R, Fernández-Vigo JI, Donate-López J. Evaluación mediante imagen de campo amplio y ultracampo amplio en la retinopatía diabética: definición y razones para ser presente en vez de futuro. Arch Soc Esp Oftalmol. 2022;97:181–183." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 902 "Ancho" => 1255 "Tamanyo" => 321583 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Composition of widefield images in patients with proliferative diabetic retinopathy. A: 163° UWF colour fundus photograph (Mirante®, Nidek®, Gamagori, Japan); B: 12 × mm12 OCT-A (Cirrus®, Carl Zeiss Meditec®, Jena, Germany); C: 23 mm UWF OCT (Silverstone®, Optos®, Dunfermline, UK)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultra-wide-field imaging in diabetic retinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Ghasemi Falavarjani" 1 => "I. Tsui" 2 => "S.R. 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ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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Citescore 2023

1.2

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SJR 2023

0.247

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SNIP 2023

0.263

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Vol. 97. Issue 4.