Peripheral retinal degenerations: multimodal imaging-guided risk stratification and clinical decision-making

Area of Science:

• Ophthalmology
• Retinal Imaging
• Vitreoretinal Surgery

Background:

• Peripheral retinal degenerations (PRD) present a spectrum from benign to high-risk lesions.
• Modern imaging increases PRD detection, but clinical relevance and management remain debated.
• Posterior vitreous detachment (PVD) is a critical factor in PRD progression to retinal tears and detachment.

Purpose of the Study:

• To establish an imaging-guided, risk-based framework for evaluating and managing PRD.
• To emphasize the role of PVD, selective prophylactic interventions, and AI in PRD management.
• To differentiate benign PRD from those with tractional instability and risk of retinal detachment.

Main Methods:

• A narrative literature search was performed across PubMed, Scopus, and Web of Science (2000-2025).
• Keywords included PRD, vitreoretinal traction, retinal tears, retinal detachment, PVD, ultra-widefield (UWF) imaging, and peripheral OCT.
• 29 of 842 identified studies were qualitatively synthesized.

Main Results:

• PRD are stratified into low-risk (atrophic), intermediate (retinoschisis), and high-risk (tractional) categories.
• UWF imaging and SS-OCT enhance visualization of peripheral morphology and vitreoretinal interface abnormalities.
• Selective prophylactic laser photocoagulation is supported for symptomatic retinal tears, fellow eye RRD, or OCT-confirmed tractional instability; routine treatment of asymptomatic low-risk PRD is not justified.

Conclusions:

• Individualized PRD management integrates clinical assessment and multimodal imaging.
• Intervention should target tractional instability and significant risk modifiers.
• AI-assisted decision support holds potential for standardizing risk interpretation and management.