New Study Confirms the Equivalence of optomap to ETDRS Gold Standard for Grading Diabetic Retinopathy

November is Diabetes Awareness Month.  In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes and approximately 1.25 million American children and adults had type 1 diabetes. These numbers are on the rise and the disease manifests with deleterious and deadly impact throughout the body – including the eye. An understanding of the disease, early detection and treatment are more imperative than ever.

 

A recent study cooperatively funded by the National Eye Institute, the National Institute of Diabetes and Digestive and Kidney diseases and the US Department of Health and Human Services concluded  that optomap ultra-widefield (UWF™) retinal imaging is a useful diagnostic tool for detection and assessment of severity of diabetic retinopathy (DR). The study published recently in JAMA Ophthalmology demonstrates that optomap UWF imaging can be used reliably in place of Early Treatment Diabetic Retinopathy Study (ETDRS) 7-Field imaging in clinical use and future clinical trials.  The paper, which builds off recent single site studies that found moderate to perfect agreement between the modalities, supports these findings through data acquired over a two-year period from multiple sites.

The gold standard assessment of DR severity has been based on grading of lesions within the ETDRS 7 standard fields. These 7 fields are time consuming in their acquisition, require dilation and once compiled represent only 34% of the retinal surface.  Advances in retinal imaging technology now allow UWF imaging to capture 82% of the retina in a single image and in less than ½ second without the need for dilation. This collaborative study offers that given the technological advances now enabling UWF imaging, and the potential benefits of this approach, there may be substantial impetus for moving to UWF imaging if it is compatible in determining DR severity, and if pathology in the retinal periphery provides additional clinically useful information on prospective worsening of retinopathy.

In this current multi-site study, there were 737 gradable eyes on both ETDRS 7-field images and UWF images masked to contain the same 7 fields after adjudication; 59% had exact agreement, and 96% were within 1 step of agreement.  The conclusion of the study clearly supported moderate to perfect agreement between modalities within the limited masked scope of the current gold standard.  As seen was seen in previous studies, when the area outside of ETDRS was assessed predominantly peripheral DR lesions (PPL) were present in 41.0% of these eyes and suggested increased DR severity  by 2 or more steps in 11.0%.

Cursorily referenced in this preliminary paper was a consideration of efficiency between modalities.  This initial study release notes that the use of UWF imaging in clinical settings not only increases the frequency of DR identification nearly 2-fold but also reduces acquisition time by more than half, ungradable image rate by 71% and image evaluation by 28% compared with non-mydriatic fundus photography.

The study suggests the possibility of UWF imaging becoming a preferred method of assessment of DR severity, not only because of moderate to perfect agreement between modalities within the ETDRS scope, but also because of the information found in UWF outside the ETDRS mask. This raises the question regarding the potential for detecting DR change and severity earlier.  Data collected from a previous study, suggests that lesions observed outside of the area captured within ETDRS may identify a possible subset of patients with the disease that may be more aggressive.  These lesions were found to suggest a 4.7 times greater risk of worsening to treatable DR over a period of four years.  That study also concludes that the identification of a subset of patients at greatly increased risk of experiencing DR progression and onset of proliferative DR that cannot be assessed by ETDRS 7-field imaging, would have important implications for the evaluation and care of diabetic eye disease.

The significance of the additional peripheral information gleaned through UWF imaging in assessing the risk of future DR progression will develop with the data collected from this ongoing study.  The complete study and summary document, as well as our entire clinical library is available on our website. We encourage you to learn more about the clinical benefits of utilizing ultra-widefield optomap in your practice or clinic.

Sources:
Comparison of Early Treatment Diabetic Retinopathy Study Standard 7-Field Imaging with Ultra Widefield Imaging for Determining Severity of Diabetic Retinopathy. Journal of American Medicine, 2018
Peripheral Lesions Identified on Ultra Widefield Imaging Predict Increased Risk of Diabetic Retinopathy Progression Over Four Years. Ophthalmology 2015

Keeping yourself, your kids, and everyone’s peepers safe this Halloween!

With Halloween upon us, dressing up is all part of the fun for both children and adults.  To ensure Halloween is fun and safe for all, it is important to take proper precautions for safety.  Each year, the US hospital emergency rooms treat several hundred eye injuries related to Halloween costumes and masks. Additionally, it is often very easy for children to be less visible to drivers during evening hours.  Prevent Blindness® has provided some helpful safety times to keep in mind this Halloween:

Costumes and Safety

-Avoid costumes with masks, wigs, floppy hats or eye patches that block vision.
-Tie hats and scarves securely so they don’t slip over children’s eyes.
-Avoid costumes that drag on the ground to prevent tripping or falling
-Avoid pointed props such as spears, swords or wands that may harm other children’s eyes.
-Wear bright, reflective clothing or decorate costumes and bags with reflective tape/patches.
-Carry a bright flashlight to improve visibility.
-Do not ride a bike/scooter/skateboard or roller blade while wearing a costume.
-Obey all traffic signals—pedestrian and driver.
-Younger children should go with an adult while trick-or-treating around the neighborhood. Older children should trick-or-treat in groups.
-Use common sense. Never dart out between parked cars or hidden corners such as alleys. Avoid streets under construction.
-Don’t trick or-treat in busy commercial areas or where there is heavy traffic.
-Go trick-or-treating in daylight, as it is safer than going after dark.
-A safer option is to go to a Halloween party instead of trick-or-treating.

Treats

-Inspect all trick-or-treat items for signs of tampering before allowing children to eat them.
-Carefully inspect any toys or novelty items received by kids age 3 and younger. These may pose a choking hazard. Avoid giving young kids lollipops as the sticks can cause eye injuries.

Decorations

-Be sure your lawn, steps, porch and front door are well lit and free from obstacles.
-Keep candles and jack-o’-lanterns away from steps and porches outside, as costumes could brush against them and ignite. Inside, keep them away from curtains and other decorations to avoid causing a fire.

Older kids often complete their Halloween costumes with spooky cosmetic contact lenses. Remember that contact lenses are medical devices and require a valid prescription. Despite this rule however, these contacts are still widely available. If you or your child do decide to wear cosmetic contact lenses, be sure to follow safety guidelines  as to not suffer vision impairment. Decorative lenses should only be purchased from a licensed eye care professional, such as an Ophthalmologist or Optometrist. Also be sure to follow all the cleaning and sterilizing instructions carefully and if you experience redness, swelling or discomfort, see an eye care professional immediately.

 

Optos would like to wish you all a happy and safe Halloween. To protect your vision, make sure you and your family receive an annual retinal exam that includes optomap®.

https://www.verywellhealth.com/halloween-eye-safety-tips-3421885
https://www.preventblindness.org/tips-making-halloween-safe

Halloween Costumes and Eye Safety


optomap Enables Detection, Diagnosis, and Guides Treatment in Age-Related Ocular Pathology

September is Healthy Aging month, however despite age related changes to vision, ocular health is often overlooked.  As the aging population grows, adding the first influx of generation X to the baby boomers in the over 50 demographics, the incidences of glaucoma and Age-related Macular Degeneration (AMD) are also on the rise.

Recent studies have demonstrated how optomap ultra-widefield™ (UWF) retinal imaging is fulfilling a need in supporting the detection and management of both ocular and systemic diseases associated with aging. UWF imaging provides a high resolution, single-capture image of 82% (or 200 degrees) of the retina.  Studies have confirmed that the resolution of the optomap image – is comparable to fundus photography – which captures 11% of the retina, in detection of diseases such as diabetic retinopathy, AMD and uveitis.  Additionally, studies have found that the additional area captured by optomap can enhance the ability to detect, diagnose and manage diseases in comparison to fundus photography and be captured more efficiently.  UWF is being increasingly used in optometric and ophthalmic settings and enables eye care professionals to detect, diagnose, document and treat ocular pathology including retinal disease that may first present in the periphery.

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in adults over age 50. The Centers for Disease Control and Prevention estimate that by the year 2020, 196 million people worldwide will be living with some form of AMD.

Although there have been many discoveries in the understanding of the causes of AMD, including links to genetics, there remains much unknown about this complicated, degenerative disease. Over time the retinal periphery has been able to be more easily studied in early AMD to determine the value in the detection and/or monitoring of the disease.  However, with the advent of multi-modality UWF imaging, novel studies are beginning to demonstrate this value. Color optomap imaging captures the structure and fundus autofluorescence (FAF) the function of the Retinal Pigment Epithelium (RPE) which is where AMD manifests within the eye. Studies have revealed that 97% of patients with AMD have evidence of the disease in the far periphery.

This outcome demonstrated that drusen were seen in a majority of eyes, strongly indicating that AMD is more than a macular condition but one that involves the entire retina. This is being investigated in a further study that will determine whether these peripheral changes are associated with the progression of the disease.   Read the Full Article

Glaucoma is another primary cause of blindness worldwide, affecting an estimated 70 million people. While early detection is key to taking steps to prevent vision loss, glaucomatous vision impairment is irreversible.  Unfortunately, glaucoma can be asymptomatic until the late stages, at which time the prognosis is poor.

The gold standard for detection and diagnosis of glaucoma is a clinical examination with dilated slit lamp biomicroscopy conducted by a glaucoma specialist.  However, this level of expertise is not always feasible or readily available to broadly evaluate an aging population. Exam efficiency has been increasingly addressed via use of color digital stereoscopic photography and/or retinal tomography via SD-OCT.

A recent  study explored the potential suitability of ultra-widefield retinal imaging in diagnosing glaucoma in situations where slit-lamp biomicroscopy or digital color stereoscopy are not available. The purpose of the study was to evaluate the reproducibility and validity of UWF in estimating Vertical Cup to Disc Ratio (VCDR) measurements and was the first study of its kind to explore whether optomap imaging could be suitable as a diagnostic support tool for glaucoma.

The study evaluated the data from color digital stereoscopic fundus images (CDS) and UWF images.  All the photographs and images were graded by two masked trained graders and one masked glaucoma specialist. The optomap images were graded using the ‘measure distance’ tool on the OptosAdvancesoftware, to measure and record cup to disc ratio (CDR).

The study demonstrated an almost perfect agreement between CDS and optomap when assessed by the glaucoma specialist.   The study concludes that optomap imaging has a high reproducibility in evaluating VCDR and agreement with stereoscopic optic disc imaging and indicates that UWF imaging may be suitable for glaucoma evaluation in settings where CDS is not available. Read the Full Article here….
Or visit our website to learn more about clinical studies utilizing optomap technology

https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/macular-degeneration
http://www.allaboutvision.com/conditions/amd.htm
https://nei.nih.gov/health/maculardegen/armd_facts
https://www.aaojournal.org/article/S0161-6420(16)31491-9/abstract
http://www.aaojournal.org/article/S0161-6420(16)31491-9/fulltext

optomap Image is a Savior to Teen’s Vision

With August deemed Children’s Eye Health and Safety Month, there cannot be enough stress placed on the importance of protecting children (including teenagers) eye health.  Healthy eyes and good vision are essential for the physical and educational development of children. Most children have healthy eyes. However, vision problems can begin at an early age and go unnoticed by both children and their parents. Early detection and treatment are indispensable in preventing conditions that could potentially cause problems or permanent vision loss.

Christina, a high school student in Manhattan Beach, California walked into her eye doctor’s office thinking it was just going to be another eye appointment and yet another glasses fitting.  Dr. Dale Choi, of Manhattan Beach Vision Group, recommended Christina get an optomap image as part of her exam that day.  To their surprise, the image revealed a significant finding.  Dr. Choi discovered a retinal hole with a large sub-clinical detachment in her left eye.  Dr. Choi reviewed the image with Christina, explaining that she would need to be referred a retina specialist that same day, to repair the hole and save her sight. Fortunately for Christina, the local specialist was able to repair the hole with no damage to her vision.

Retinal Detachment – Image courtesy J Edward Ysasaga, MD

According to Dr. Choi, optomap has diagnosed many systemic conditions that otherwise would have gone unknown and often gotten worse.  Without it the optomap, Christina is unsure how she would have known about the detached retina before it was too late.  “It gives them peace of mind. It gives them ultimately the care that should be standard in all eye exams,“ says Dr. Choi.

Optos is committed to educating parents on the importance of having their children’s eyes checked regularly. Protect your children’s eye health by making an optomap part of their yearly comprehensive eye exam.  Visit our website for more sight-saving stories like Christina’s and find an optomap provider near you to schedule your child’s eye exam today!

https://www.preventblindness.org

Back to School Means More Than Backpacks and Lunch Boxes – Don’t Forget the Eye Exam!

While to some it may feel as though summer has just begun, others are already feeling the pressures of checking off every item on their back to school lists.  With all the hassle of stocking up on school supplies or finding the perfect pair of shoes, there is often one important item that gets left off every parent’s list – a comprehensive eye exam.  Although schools generally do some basic testing of children’s vision, there is no doctor to perform a comprehensive exam or diagnose problems with your child’s eyesight.  According to experts, nearly 90 percent of what is taught in school is done so visually, therefore without excellent vision, children are left at a disadvantage.  Those with poor eyesight may struggle with school and learning, leaving them unable to reach their maximum potential.  A yearly comprehensive eye exam can not only ensure your child’s vision is healthy or corrected, but also rule out diseases that can potentially lead to vision loss.

Just as their bodies are rapidly growing, children’s eye are also changing. The slightest change in vision can cause eye strain, headaches or blurred vision which can be very distracting in school.  Myopia and hyperopia, also known as near or farsightedness, are both common conditions in young children, with the ability to worsen rapidly during the growing years until later stabilizing in teenage years and into their early twenties.

Additionally, with recent increases in digital technology, both at home and in schools, it is important to monitor the face time children and teens have with their digital devices such as laptops, tablets and cell phones.  Many individuals suffer from physical eye discomfort after screen use for more than two hours, reflecting collective symptoms know as digital eye strain.  According to The Vision Council, 72 percent of Americans report their children and teens get more than two hours of screen time per day while 30 percent of this group report they experience at least one of the following symptoms after being exposed for more than two hours:

  • Headaches
  • Neck/shoulder pain
  • Eye strain, dry or irritated eyes
  • Reduced attention span
  • Poor behavior
  • Irritability

With a growing number of schools implementing iPads, tablets or laptops in the classroom, it is even more important to ensure your children’s eye health with routine comprehensive eye exams and identifying any symptoms of digital eye strain in addition to any headaches, eye strain or blurred vision.

Adding comprehensive eye exams to your yearly back to school routines will help ensure a successful school year as well as protect your children’s eye health and future.  Speak to your doctor about including optomap® as part of the exam – it is a non-invasive option for your child and takes only seconds to get a highly-detailed view of the retina, which is critical for early disease detection.

http://yoursightmatters.com/make-eye-exams-back-school-tradition/
https://www.allaboutvision.com/parents/learning.htm
https://www.thevisioncouncil.org/content/digital-eye-strain/teens