OSLI Retina

October 2019

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October 2019 · Vol. 50, No. 10 639 Protecting Vision in Patients With Diabetes With Ultra-Widefield Imaging: A Review of Current Literature Rishi P. Singh, MD; Jessica Hsueh; Michael M. Han; Ajay E. Kuriyan, MD; Felipe F. Conti, MD; Nathan Steinle, MD; Christina Y. Weng, MD, MBA; Robert W. Wong, MD; Jose A. Martinez, MD; Charles C. Wykoff, MD, PhD ABSTRACT: Ultra-widefield fundus imaging (UWFI) is a relatively new technology capable of capturing 200° images of the retina. Since vision changes can be irreversible in diabetic retinopathy (DR), recog- nition of prognostic biomarkers in the peripheral retina may prove invaluable toward optimizing the management and reducing the societal burden of this blinding disease. Following a bibliographic re- view using Pubmed, OVID Medline, Embase, and the Cochrane Library, the current review system- atically examined 13 studies that compared UWFI to conventional screening techniques such as seven standard field (7SF) Early Treatment In Diabetic Retinopathy Study (ETDRS) and non-mydriatic multifield fundus photography (NMFP), as well as their scientific level of evidence. Overall, UWFI had good agreement with 7SF ETDRS and NMFP, and moderate agreement with dilated fundus examina- tion. Seven additional studies were examined that considered the significance of peripheral lesions found on UWFI. These studies demonstrated that UWFI captured additional DR pathology in the pe- ripheral retina that may not be evident if evaluation is limited to the posterior pole and may be relevant to patient outcomes. Future directions include but are not limited to the potential of UWFI to track the progression of DR with treatment. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:639-648.] INTRODUCTION Diabetes and its complications represent a looming public health crisis. As of 2017, 23.1 million people in the U.S. population have diabetes, and an estimated 7.2 million people are undiagnosed. 1 Diabetic retinopathy (DR) is one of the leading causes of adult vision loss in the developed world. Furthermore, From Case Western Reserve University School of Medicine, Cleveland, Ohio (RPS, JH, MH); Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio (RPS, FFC); the Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio (RPS, FFC); Flaum Eye Insti- tute, University of Rochester Medical Center, Rochester, New York (AEK); California Retina Consultants, Santa Barbara, California (NS); Cullen Eye Institute, Baylor College of Medicine, Houston, Texas (CYW); Austin Retina Associates, Austin, TX and Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas (RWW, JAM); Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, Texas (CCW). © 2019 Singh, Hsueh, Han, et al.; licensee SLACK Incorporated. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International (https://creativecommons.org/ licenses/by/4.0). This license allows users to copy and distribute, to remix, transform, and build upon the article, for any purpose, even commercially, provided the author is attributed and is not represented as endorsing the use made of the work. Originally submitted November 16, 2018. Revision received January 28, 2019. Accepted for publication March 25, 2019. Dr. Singh has received personal fees from Optos and Zeiss during the conduct of the study, as well as grants and personal fees from Regeneron, Novartis/Alcon, and Genentech and personal fees from Bausch + Lomb outside the submitted work. Dr. Kuriyan has received personal fees from Allergan, Alimera Sciences, and Regeneron, and grants from Genentech, Second Sight, and Bayer outside the submitted work. Dr. Weng has received personal fees from Allergan and Alimera Sciences outside the submitted work. Dr. Wykoff has received grants from Adverum Biotech- nologies, Aerpio Therapeutics, Alcon Laboratories, Aldeyra Therapeutics, Allegro, Apellis Pharmaceutical, Astellas Pharma, Aura Biosciences, Boehringer Ingelheim, Chiltern International, Heidelberg Engineering, Iconic Therapeutics, inc Research, Johns Hopkins University, NEI, OHR Pharmaceuticals, Ophthotech Corp, Regenxbio, SciFluor Life Sciences, Taiwan Liposome Company and Tyrogenex; personal fees from Alimera Sciences, Alnylam Pharmaceuticals, Bayer, CORCEPT, DORC International, Evolve Medical Education, k2c Medical Communications, Kodiak Sciences, Notal Vision, ONL Pharmaceuticals, and PRIME Educations; and grants and personal fees from Clearside Biomedical, EyePoint (formerly pSivida), Genentech, Novartis, Regeneron Pharmaceuticals, and Santen outside the submitted work. The remaining authors report no relevant financial disclosures. Dr. Singh did not participate in the editorial review of this manuscript. Address correspondence to Rishi P. Singh, MD, 9500 Euclid Avenue, Desk i32, Cleveland, OH 44195; email: SINGHR@ccf.org. doi: 10.3928/23258160-20191009-07 ■ I M A G I N G R E V I E W ■

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