The Role of Ultra-widefield Retinal Imaging as a Standard Assessment Tool in the Cataract Practice

US Ophthalmic Review, 2017;10(1):31–4 DOI: https://doi.org/10.17925/USOR.2017.10.01.31

Abstract:

Comprehensive evaluation of retinal health prior to and following cataract surgery is critical to supporting optimal outcomes. In addition to the importance of identifying retinal pathology that may prevent or delay cataract surgery, continuous advances in refractive intraocular lens technology and cataract surgical technique, coupled with increasingly high expectations regarding visual outcomes among younger patients, make the consideration of long-term quality of vision paramount in the cataract assessment. Optos® ultrawidefield retinal imaging supports this clinical objective by providing imaging standardization in a streamlined, patient-friendly exam process, supporting robust documentation that facilitates mapping of disease progression, and offering potential economic advantages in a resourceconstrained environment.
Keywords: Ultra-widefield retinal imaging, UWF, cataract surgery, multifocal IOL, retinal periphery
Disclosure: Kerry K Assil has nothing to disclose in relation to this article. V Nicholas Batra participated in a panel case presentation sponsored by Optos
Acknowledgments: Editorial assistance was provided by BioComm Network, Inc.

Compliance with Ethics: This study a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.

Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

Received: February 06, 2017 Accepted March 22, 2017
Correspondence: Kerry K Assil, 450 N. Roxbury Dr., 3rd Floor, Beverly Hills, CA 90210, US. E: kerry@assileye.com
Support: The publication of this article was supported by Optos. The views and opinions expressed are those of the authors and do not necessarily reflect those of Optos.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit.

Due in part to continuous improvement in the safety, speed, and refractive outcomes of cataract surgery, the number of cataract procedures has increased steadily over the past 30 years, and the percentage of patients undergoing the procedure at a younger age is also increasing. These trends were documented in a frequently cited population-based study of Omsted County, Minnesota, that compared rates of cataract surgery between 2005 and 2011 to those in the prior 25 years. Data on more than 8,000 cataract procedures in the most recent period revealed that the incidence of cataract surgery had increased significantly, the interval between first and second eye surgery narrowed significantly, and 19% of patients elected cataract surgery before age 65.1 This rise in cataract surgery rates will continue to accelerate as the US population ages; the number of Americans over age 65 is expected to nearly double by 2050, to 83.7 million.2

Along with the increasing volume driven by this large demographic wave, there are a number of important implications of the shift to earlier cataract surgery and the increasing use of sophisticated premium intraocular lens (IOL) technologies. Perhaps the most significant of these is that many patients will live for decades after the procedure. These patients have high expectations of their immediate postoperative visual outcomes and also expect to continue to see well as they age. With sustained quality of vision the main therapeutic objective, it has become paramount to perform thorough retinal exams pre-surgically and postoperatively to identify pre-existing retinal disease that might prevent, delay, or alter surgery, to anticipate future retinal problems—particularly to the degree that this prospect may affect lens choice—and to provide an initial, post-cataract baseline for monitoring future pathological changes. In this review, we will describe the integration into our pre- and post-cataract surgery assessments of a specific imaging technology that has shown utility in retinal disease detection and management for both the general ophthalmologist and the retinal specialist. In our experience, ultra-widefield (UWF™) retinal imaging (Optos plc., Dunfermline, Scotland) and the clinical and practical value of the high-resolution, digital optomap® images they produce, have complemented the information available to us from standard approaches, including conventional fundus examination and optical coherence tomography (OCT), thereby improving our ability to rapidly and accurately identify retinal pathology, facilitating consultation with retina colleagues, and resulting in enhanced patient care, increased patient satisfaction, and greater efficiency within our practices. As a result, Optos® UWF retinal imaging has become a routine component of perioperative evaluation in our cataract cases, based on the unique advantages of the technology, and we believe that other cataract practices may benefit from considering this approach.

Relevant capabilities of ultra-widefield retinal imaging for the cataract practice
As occurred with the introduction of OCT, now an essential tool in many cataract practices, UWF retinal imaging is providing new capabilities that are helping to evolve the standard of care. Several platforms for examining the retinal periphery have been developed, including the portable, contact-based RetCam (Natus Medical, Plesanton, California, US) and contact (Staurenghi retinal lens—Ocular Instruments, Washington, US) and non-contact lens additions to the Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany), but the Optos systems offer the maximum field of view of any available retinal imaging device.3 Optos UWF devices are also easier to use and capture images more quickly than other platforms. A single, non-contact capture can show 200-degrees or 82% of the retina, often extending beyond the vortex veins and equator. A number of studies have confirmed that Optos UWF imaging helps clinicians identify pathology associated with a wide array of retinal diseases, including non-infectious uveitis and vasculitis, that can be missed with conventional imaging techniques.4–6 A review of data from more than 3 years of research with UWF imaging confirmed that that 66% of clinically relevant retinal pathology is found outside the reach of conventional fundus photography.7

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Keywords: Ultra-widefield retinal imaging, UWF, cataract surgery, multifocal IOL, retinal periphery