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Ultra-widefield Imaging of the Peripheral Retinal Vasculature in Normal Subjects

  • Author Footnotes
    ∗ Both Dr. Singer and Dr. Sagong contributed equally as first authors.
    Michael Singer
    Footnotes
    ∗ Both Dr. Singer and Dr. Sagong contributed equally as first authors.
    Affiliations
    Department of Ophthalmology, Medical Center Ophthalmology Associates, San Antonio, Texas
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  • Author Footnotes
    ∗ Both Dr. Singer and Dr. Sagong contributed equally as first authors.
    Min Sagong
    Footnotes
    ∗ Both Dr. Singer and Dr. Sagong contributed equally as first authors.
    Affiliations
    Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California

    Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
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  • Jano van Hemert
    Affiliations
    Optos Plc, Dunfermline, United Kingdom
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  • Laura Kuehlewein
    Affiliations
    Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California

    Institute for Ophthalmic Research, Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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  • Darren Bell
    Affiliations
    Department of Ophthalmology, Medical Center Ophthalmology Associates, San Antonio, Texas
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  • SriniVas R. Sadda
    Correspondence
    Correspondence: SriniVas R. Sadda, MD, Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, 1450 San Pablo Street, DEI 3623, Los Angeles, CA 90033.
    Affiliations
    Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
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  • Author Footnotes
    ∗ Both Dr. Singer and Dr. Sagong contributed equally as first authors.
Published:February 17, 2016DOI:https://doi.org/10.1016/j.ophtha.2016.01.022

      Purpose

      To establish the extent of the peripheral retinal vasculature in normal eyes using ultra-widefield (UWF) fluorescein angiography.

      Design

      Prospective, observational study.

      Participants

      Fifty-nine eyes of 31 normal subjects, stratified by age, with no evidence of ocular disease in either eye by history and ophthalmoscopic examination.

      Methods

      Ultra-widefield fluorescein angiographic images were captured centrally and with peripheral steering using the Optos 200Tx (Optos, Dunfermline, United Kingdom). Images obtained at different gaze angles were montaged and corrected for peripheral distortion using a stereographic projection method to provide a single image for grading of the peripheral edge of the visible vasculature. The border of the vascularized retina was expressed as a radial surface distance from the center of the optic disc. The vascularized area was calculated based on this mean peripheral border position for each quadrant.

      Main Outcome Measures

      Mean distance (mm) from the center of optic disc to the peripheral vascular border.

      Results

      In normal eyes, the mean radial surface distance from the center of the optic disc to the peripheral edge of the visible vasculature was 20.3±1.4 mm and the mean area of normal perfused retina was 977.0 mm2. There was no significant difference between right and left eyes or between male and female participants. However, the distance to the periphery differed depending on the quadrant, with temporal (22.5±0.9 mm) being larger than inferior (20.4±1.7 mm) being larger than superior (19.2±1.5 mm) being larger than nasal (17.4±0.9 mm; P < 0.001) for all interquadrant comparisons. Interestingly, the distances to the perfused vascular border were significantly shorter in older individuals (≥60 years) than in younger subjects.

      Conclusions

      Ultra-widefield fluorescein angiography is an important tool for studying the extent of peripheral retinal vasculature. With the increasing use of UWF imaging to evaluate and manage patients with retinal vascular disease, the normative data from this study may provide a useful reference when assessing the pathologic significance of findings in the setting of disease.

      Abbreviations and Acronyms:

      D (diopter), DD (disc diameter), FA (fluorescein angiography), ICC (interclass correlation coefficient), UWF (ultra-widefield)
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