PURPOSE: To determine whether the use of ultra wide-field imaging changes the management or determination of disease activity in patients with noninfectious posterior uveitis. DESIGN: Prospective, observational case series. METHODS: setting: Divisions of Retina and Ocular Immunology at single academic medical center. patient population: Total of 43 patients with noninfectious posterior uveitis seen by 4 investigators at the Wilmer Eye Institute. procedures: Each patient underwent standard clinical examination, followed by ultra wide-field scanning laser ophthalmoscope (SLO) imaging and angiography. Investigators successively determined disease activity and management decisions based on clinical examination, examination plus simulated 30- or 60-degree fluorescein angiography (FA) (obtained by physically narrowing the field of view of the wide-field images), examination plus ultra wide-field SLO images, and examination plus wide-field FA. main outcome measures: The primary outcome was the percentage of patients whose management changed based on the availability of wide-field imaging, compared with standard examination and imaging. The secondary outcome was detection of disease activity with and without wide-angle imaging. RESULTS: Management was altered in 7 of 43 patients (16%) based on examination and limited FA, whereas 21 of 43 patients (48%) had management change with the use of the ultra wide-field imaging and angiography (P < .001). Disease activity was detected in 22 of 43 patients (51%) based on examination and simulated conventional imaging, and in 27 of 43 (63%) with wide-field imaging (P = .27). CONCLUSIONS: The index study, with several design limitations, has suggested that ultra wide-field imaging may alter management decisions compared to standard-of-care imaging and clinical examination. Additional studies, including longitudinal evaluations, are needed to determine whether these findings, or the subsequent management alterations, may improve patient outcomes.
PURPOSE: To determine whether the use of ultra wide-field imaging changes the management or determination of disease activity in patients with noninfectious posterior uveitis. DESIGN: Prospective, observational case series. METHODS: setting: Divisions of Retina and Ocular Immunology at single academic medical center. patient population: Total of 43 patients with noninfectious posterior uveitis seen by 4 investigators at the Wilmer Eye Institute. procedures: Each patient underwent standard clinical examination, followed by ultra wide-field scanning laser ophthalmoscope (SLO) imaging and angiography. Investigators successively determined disease activity and management decisions based on clinical examination, examination plus simulated 30- or 60-degree fluorescein angiography (FA) (obtained by physically narrowing the field of view of the wide-field images), examination plus ultra wide-field SLO images, and examination plus wide-field FA. main outcome measures: The primary outcome was the percentage of patients whose management changed based on the availability of wide-field imaging, compared with standard examination and imaging. The secondary outcome was detection of disease activity with and without wide-angle imaging. RESULTS: Management was altered in 7 of 43 patients (16%) based on examination and limited FA, whereas 21 of 43 patients (48%) had management change with the use of the ultra wide-field imaging and angiography (P < .001). Disease activity was detected in 22 of 43 patients (51%) based on examination and simulated conventional imaging, and in 27 of 43 (63%) with wide-field imaging (P = .27). CONCLUSIONS: The index study, with several design limitations, has suggested that ultra wide-field imaging may alter management decisions compared to standard-of-care imaging and clinical examination. Additional studies, including longitudinal evaluations, are needed to determine whether these findings, or the subsequent management alterations, may improve patient outcomes.
Authors: Akshay S Thomas; Travis Redd; John P Campbell; Neal V Palejwala; Justin T Baynham; Eric B Suhler; James T Rosenbaum; Phoebe Lin Journal: Ocul Immunol Inflamm Date: 2017-10-16 Impact factor: 3.070
Authors: Apurva K Patel; Craig W Newcomb; Teresa L Liesegang; Siddharth S Pujari; Eric B Suhler; Jennifer E Thorne; C Stephen Foster; Douglas A Jabs; Grace A Levy-Clarke; Robert B Nussenblatt; James T Rosenbaum; H Nida Sen; Pichaporn Artornsombudh; Srishti Kothari; John H Kempen Journal: Ophthalmology Date: 2015-12-11 Impact factor: 12.079
Authors: Michael A Klufas; Samir N Patel; Michael C Ryan; Mrinali Patel Gupta; Karyn E Jonas; Susan Ostmo; Maria Ana Martinez-Castellanos; Audina M Berrocal; Michael F Chiang; R V Paul Chan Journal: Ophthalmology Date: 2015-05-28 Impact factor: 12.079
Authors: Benjamin P Nicholson; Divya Nigam; Darby Miller; Elvira Agrón; Monica Dalal; Naima Jacobs-El; Breno da Rocha Lima; Denise Cunningham; Robert Nussenblatt; H Nida Sen Journal: Am J Ophthalmol Date: 2013-12-07 Impact factor: 5.258