Sensitivity of Ultra-Widefield Imaging in Detecting Retinal Tears

Abstract

Purpose : Posterior vitreous detachments are common ophthalmologic pathology that require thorough peripheral retinal evaluation to rule-out retinal tears (RT), which may progress to sight-threatening retinal detachments (RD) if not treated promptly. Ultra-widefield (UWF) retinal imaging has become a key tool in clinical care, as this technology is able to capture approximately 82% of the retinal surface area. However, the sensitivity of UWF imaging for RTs in a clinical setting has not been established. We performed a retrospective chart review to evaluate the sensitivity of UWF for RTs.

Methods : Study participants were seen at The Shiley Eye Institute, Viterbi Family Department of Ophthalmology at UC San Diego between 2015 – 2022. All patients received a clinical diagnosis of at least one RT by scleral depressed examination (SDE), underwent UWF imaging centered on the fovea and laser retinopexy. Patients with associated ruptured globes, vitreous hemorrhage and/or rhegmatogenous RD requiring surgery were excluded. The primary outcome was the number of RTs captured by UWF imaging. A secondary outcome was tear location. Sensitivity was measured with respect to tear location and statistical significance was calculated by chi-squared testing.

Results : 123 patients were enrolled in the study. There were 64 (52.0%) males and 59 (47.9%) females with an average age of 57.3 years. A total of 135 RTs were diagnosed in 69 (51.1%) right and 66 (48.9%) left eyes. Of these RTs, 69 (51.1%) were visualized on the foveal-centered UWF images and 66 (48.9%) were not visualized. The sensitivity of UWF images in capturing tears were 7/41 (17.1%), 8/25 (32.0%), 7/14 (50.0%), and 47/55 (85.5%) for the superior, inferior, nasal and temporal quadrants, respectively (Table 1, Figure 1). There was a significant relationship between the location of the tears and visibility upon analysis of both quadrants and clock hours (quadrants: X² = 48.6, p-value = 1.56e-10, clock hours: X² = 51.6, p-value = 3.24e-7).

Conclusions : Nearly 50% of RTs found on SDEs were missed on foveal-centered UWF imaging, with the majority of missed tears found on SDEs in the superior and inferior poles. Although UWF imaging is described to have a 200° field of view covering 82% of the retina into the far periphery, it is not a sufficiently sensitive tool to evaluate for RTs.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1. UWF Imaging Visibility of RTs (Quadrants)

 

Figure 1. Sensitivity of UWF Imaging Visibility of RTs (Clock Hours)