Visualization of the Persistent Avascular Retina with Ultra-Widefield Green Reflectance Imaging

Area of Science:

• Ophthalmology
• Medical Imaging
• Pediatric Eye Care

Background:

• Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
• Early detection of persistent avascular retina (PAR) is crucial for managing ROP.
• Ultra-widefield (UWF) fundus imaging is essential for visualizing the peripheral retina in ROP.

Purpose of the Study:

• To compare the efficacy of different color imaging modes in UWF fundus photography for detecting PAR in pediatric ROP patients.
• To determine which color reflectance imaging best visualizes the peripheral avascular retina.

Main Methods:

• 10 children (20 eyes) with ROP underwent UWF fundus imaging using Optos cSLO.
• Images were analyzed in composite, red reflectance, and green reflectance modes.
• 10 ophthalmology specialists evaluated the ease of PAR detection across imaging types.

Main Results:

• Green reflectance imaging showed a statistically significant higher rate of PAR detection (0.94 ± 0.06) compared to composite (0.63 ± 0.09) and red reflectance (0.12 ± 0.05) imaging (p < 0.0001).
• All specialists reported clearer definition of avascular area boundaries with green reflectance imaging.
• Lower green laser penetration into choroidal vessels enhances visualization of retinal vascular endings.

Conclusions:

• UWF green reflectance imaging is superior for detecting and monitoring PAR in ROP.
• The distinct visualization of retinal vascular endings in green reflectance imaging aids in early ROP management.
• Different color imaging modes offer complementary information on retinal layers.