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Comparison of Ultra-Widefield Fluorescein Angiography With the Heidelberg Spectralis(®) Noncontact Ultra-Widefield Module Versus the Optos(®) Optomap(®)

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Comparison of Ultra-Widefield Fluorescein Angiography With the Heidelberg Spectralis(®) Noncontact Ultra-Widefield Module Versus the Optos(®) Optomap(®)

Matthew T Witmer et al. Clin Ophthalmol.

Abstract

Purpose: To compare ultra-widefield fluorescein angiography imaging using the Optos(®) Optomap(®) and the Heidelberg Spectralis(®) noncontact ultra-widefield module.

Methods: Five patients (ten eyes) underwent ultra-widefield fluorescein angiography using the Optos(®) panoramic P200Tx imaging system and the noncontact ultra-widefield module in the Heidelberg Spectralis(®) HRA+OCT system. The images were obtained as a single, nonsteered shot centered on the macula. The area of imaged retina was outlined and quantified using Adobe(®) Photoshop(®) C5 software. The total area and area within each of four visualized quadrants was calculated and compared between the two imaging modalities. Three masked reviewers also evaluated each quadrant per eye (40 total quadrants) to determine which modality imaged the retinal vasculature most peripherally.

Results: Optos(®) imaging captured a total retinal area averaging 151,362 pixels, ranging from 116,998 to 205,833 pixels, while the area captured using the Heidelberg Spectralis(®) was 101,786 pixels, ranging from 73,424 to 116,319 (P = 0.0002). The average area per individual quadrant imaged by Optos(®) versus the Heidelberg Spectralis(®) superiorly was 32,373 vs 32,789 pixels, respectively (P = 0.91), inferiorly was 24,665 vs 26,117 pixels, respectively (P = 0.71), temporally was 47,948 vs 20,645 pixels, respectively (P = 0.0001), and nasally was 46,374 vs 22,234 pixels, respectively (P = 0.0001). The Heidelberg Spectralis(®) was able to image the superior and inferior retinal vasculature to a more distal point than was the Optos(®), in nine of ten eyes (18 of 20 quadrants). The Optos(®) was able to image the nasal and temporal retinal vasculature to a more distal point than was the Heidelberg Spectralis(®), in ten of ten eyes (20 of 20 quadrants).

Conclusion: The ultra-widefield fluorescein angiography obtained with the Optos(®) and Heidelberg Spectralis(®) ultra-widefield imaging systems are both excellent modalities that provide views of the peripheral retina. On a single nonsteered image, the Optos(®) Optomap(®) covered a significantly larger total retinal surface area, with greater image variability, than did the Heidelberg Spectralis(®) ultra-widefield module. The Optos(®) captured an appreciably wider view of the retina temporally and nasally, albeit with peripheral distortion, while the ultra-widefield Heidelberg Spectralis(®) module was able to image the superior and inferior retinal vasculature more peripherally. The clinical significance of these findings as well as the area imaged on steered montaged images remains to be determined.

Keywords: peripheral; retina; ultra-widefield; wide-angle; widefield.

Figures

Figure 1
Figure 1
Fluorescein angiogram of the right eye of a patient showing a single-shot, noncontact image centered on the macula. (A) Heidelberg Spectralis® (Heidelberg Engineering, Heidelberg, Germany); (B) Optos® Optomap® (Optos PLC, Dunfermline, UK). Notes: After outlining the area of the retina imaged (areas included were those with visible retinal and/or choroidal vasculature, while artifacts, including the eyelids and eyelashes, were excluded from the pixel calculation), the photographs were divided into four quadrants, superior, inferior, temporal, and nasal, centered on the macula (dashed lines). The total number of pixels in the image as well as the number of pixels in each quadrant were calculated using Adobe® Photoshop® C5 software (Adobe Systems Inc, San Jose, CA, USA) and were compared between the two modalities.
Figure 2
Figure 2
Ultra-widefield fluorescein angiogram of the left eye of a patient with Von Hippel-Lindau syndrome. (A) Optos® Optomap® (Optos PLC, Dunfermline, UK); (B and C) Heidelberg Spectralis® (Heidelberg Engineering, Heidelberg, Germany). The total retinal surface area visualized on a single-shot image was considerably greater with the Optos® Optomap® compared with the Heidelberg Spectralis®. Two retinal hemangioblastomas are noted in the inferotemporal quadrant (arrows in A and C). With the patient in primary gaze (A and B), only the Optos® Optomap®, and not the Heidelberg Spectralis®, clearly shows these two lesions (arrows in A). With the patient looking inferotemporally (C), the Heidelberg Spectralis® ultra-widefield module is able to capture the two retinal hemangioblastomas (arrows in C).
Figure 3
Figure 3
Ultra-widefield fluorescein angiogram of the right eye of the same patient with Von Hippel-Lindau syndrome, shown in Figure 2. (A) Optos® Optomap® (Optos PLC, Dunfermline, UK); (B) Heidelberg Spectralis® (Heidelberg Engineering, Heidelberg, Germany). Notes: In primary gaze, the Optos® Optomap® shows one retinal hemangioblastoma in the inferotemporal quadrant (arrow). The superior and inferior quadrants are not as distinctly visualized by the Optos® Optomap® compared with the nasal and temporal quadrants. In primary gaze, the Heidelberg Spectralis® ultra-widefield image shows two retinal hemangioblastomas (arrows). The superior retinal hemangioblastoma visualized with the Heidelberg Spectralis® was not seen on single-shot, nonsteered image obtained with the Optos® Optomap® taken in primary position.

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