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Karen Michelle Wai, Jade Moon, Mohammad Dahrouj, John Miller; Application of a Digital Green Filter for Improved Visualization of Retinal Breaks on Ultra-Widefield Fundus Imaging. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1885.
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Ultra-widefield fundus photos have enabled eyecare professionals to better visualize and document retinal pathology. Optos (Optos P200DTx icg, Optos, Marlborough, MA, USA) is an ultra-widefield imaging system that creates pseudocolor photos by combining red (633 nm) and green (532 nm) laser sources. We hypothesize that applying an additional digital green filter overlay relative to the traditional settings of an Optos fundus photo may better highlight retinal breaks. Green light, given its shorter wavelength, will focus on the retina more superficially at the level of retinal vessels, relative to red light, which is focused on the retinal pigment epithelium and choroid.
Seventeen ophthalmology residents from a single institution were tested. Residents were presented with fundus photos of 10 eyes from 10 patients taken on the Optos system with either a retinal tear or hole. Participants were shown each fundus photo twice in a randomized order – once with traditional color settings and once with the addition of a green filter overlay. Participants were asked to identify the retinal break. Participants were scored on whether the break was correctly identified and timed on how long it took to identify the pathology, with a maximum of 20 seconds to examine each photo.
On average, residents were able to identify more breaks on fundus photos with the green filter overlay compared to the standard settings (8.6/10 vs. 6.8/10, p<0.01). Residents were also able to correctly identify breaks on the fundus photos more quickly on images with green filter overlay relative to standard settings (7.5 seconds vs. 9.1 seconds, p<0.05). On a post-test survey, fifteen residents (88.2%) felt that the green filter overlay made it easier to identify retinal breaks, while two (11.8%) could not tell a difference. Fifteen residents (88.2%) felt a green filter overlay would be a useful tool in ophthalmology clinics and for telemedicine application.
Fundus ultra-widefield imaging has become an essential tool in identifying and documenting retinal pathology, especially in the era of teleophthalmology. Application of a green filter overlay may help in identifying retinal breaks for eyecare providers at all levels of training.
This is a 2021 ARVO Annual Meeting abstract.
Retinal tear (arrow) on a) Traditional Optos image and b) Optos image with green filter overlay.
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