Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis

John Campbell, Henry Alexander Leder, Yasir Jamal Sepah, Theresa Gan, James P. Dunn, Elham Hatef, Brian Cho, Mohamed Ibrahim, Millena Bittencourt, Roomasa Channa, Diana V. Do, Quan Dong Nguyen

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Ophthalmology
DOIs
StateAccepted/In press - 2012
Externally publishedYes

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Posterior Uveitis
Retinaldehyde
Fluorescein Angiography
Ophthalmoscopes
Angiography
Lasers
Research Personnel
Standard of Care
Disease Management
Allergy and Immunology
Longitudinal Studies
Retina
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis. / Campbell, John; Leder, Henry Alexander; Sepah, Yasir Jamal; Gan, Theresa; Dunn, James P.; Hatef, Elham; Cho, Brian; Ibrahim, Mohamed; Bittencourt, Millena; Channa, Roomasa; V. Do, Diana; Nguyen, Quan Dong.

In: American Journal of Ophthalmology, 2012.

Research output: Contribution to journalArticle

Campbell, J, Leder, HA, Sepah, YJ, Gan, T, Dunn, JP, Hatef, E, Cho, B, Ibrahim, M, Bittencourt, M, Channa, R, V. Do, D & Nguyen, QD 2012, 'Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis', American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2012.05.019
Campbell, John ; Leder, Henry Alexander ; Sepah, Yasir Jamal ; Gan, Theresa ; Dunn, James P. ; Hatef, Elham ; Cho, Brian ; Ibrahim, Mohamed ; Bittencourt, Millena ; Channa, Roomasa ; V. Do, Diana ; Nguyen, Quan Dong. / Wide-field Retinal Imaging in the Management of Noninfectious Posterior Uveitis. In: American Journal of Ophthalmology. 2012.
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abstract = "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.",
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AU - Hatef, Elham

AU - Cho, Brian

AU - Ibrahim, Mohamed

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AU - V. Do, Diana

AU - Nguyen, Quan Dong

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