Optomap ultrawide field imaging rapid screening peripheral retinal lesions before refractive surgery

Optomap ultrawide field imaging rapid screening peripheral retinal lesions before refractive surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Optomap ultrawide field imaging rapid screening peripheral retinal lesions before refractive surgery Ruiling Zhu, Wang Cai, Lijia Luo, Shengguo Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3767813/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: The aim of this study was to assess the effectiveness of Optomap ultrawide field imaging for swiftly screening retinal lesions in individuals who have undergone refractive surgery. Methods : This retrospective study involved 400 eyes from 200 refractive surgery patients. All participants underwent post-dilated Optomap imaging and a 90D lens fundus examination conducted by a retinal specialist. The study focused on peripheral retinal lesions, including retinal holes/tears, peripheral lattice or pigmentary degeneration, and vitreoretinal traction, while excluding conditions like myopic conus, white without pressure, and snowflake degeneration. The 90D lens examination was established as the gold standard. Sensitivity and specificity of Optomap images were calculated and analyzed. The study compared the differences between the two screening methods for retinal lesions, utilizing the Chi-square test for statistical analysis. Results : Among the 400 eyes, the retinal specialist diagnosed peripheral retinal lesions in 54 eyes (13.5%) through dilated 90D examination and in 37 eyes (10.25%) through Optomap images. The difference between these two methods was not statistically significant (p=0.06). The overall sensitivity and specificity of the Optomap images were 75.9% and 95.31%, respectively. However, there were significant differences in the diagnosis of vitreous adhesion between the two methods (p=0.03). Conclusion : Optomap proves to be a convenient and effective tool for screening retinal lesions in refractive surgery patients. However, for cases involving peripheral vitreoretinal traction situated above or below the peripheral retina, a meticulous examination with the 90D lens fundus examination is recommended for comprehensive evaluation and accurate diagnosis. Optomap Myopia Refractive surgery Peripheral retinal lesions Prophylactic laser Figures Figure 1 Figure 2 Figure 3 1. Introduction At present, with the tremendous advancements in corneal refractive surgery, Small incision lenticule extraction (SMILE) and Femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) have been accepted by more and more myopic people. Myopia is not a simple ametropia but can cause some retinal lesions, such as retinal breaks, lattice degeneration, lacquer cracks, macular hemorrhage, and posterior staphyloma[ 1 ] 1 . Though the association of refractive surgery with rhegmatogenous retinal detachment (RRD) remains controversial, some reported that the occurrence rate of RRD after refractive surgery is 0.06–0.25%[ 2 – 4 ]. Therefore, a comprehensive fundus examination is necessary before surgery. Traditionally, the Goldmann three-mirror contact lens examination has served as the gold standard for fundus examination. However, its application in examining refractive patients comes with limitations. The procedure necessitates a topical anesthetic and involves close corneal contact, potentially leading to edema or damage to the corneal epithelium. This close contact may also impact the accurate measurement of the corneal topographic map and elevate the risk of infection during surgery. Although the 90D lens for fundus examination has been widely used in refractive patient screening, it also presents limitations, requiring active patient cooperation and consuming a relatively extended period. Particularly during winter and summer vacations, when the number of patients with refractive errors rises significantly, there is an urgent need for a fast, reliable, and convenient method to screen for potential retinopathy. The Optomap employs an ellipsometer to capture a wide-field, high-quality retinal image spanning over 200 degrees, recording peripheral retinal vision without the need for mydriasis and corneal contact. A skilled technician can obtain high-quality Optomap fundus images in less than 0.4 seconds[ 5 ]. Recognizing the advantages of Optomap, it is extensively utilized for screening early diabetic retinopathy[ 6 ], in ocular casualty settings[ 7 ], and for detecting peripheral retinal lesions[ 8 ]. Despite these applications, few reports have explored Optomap ultrawide field imaging for screening peripheral retinal lesions under mydriasis before refractive surgery. Consequently, this study aims to compare the diagnostic capabilities of the Optomap (Daytona P200T) with the slit-lamp 90D lens under mydriasis during fundus examination. The goal is to evaluate the role of Optomap in swiftly screening retinal lesions among refractive patients. 2. METHODS 2.1 Subjects This retrospective study received approval from the Changsha Aier's Eye Hospital Institutional Review Board (IRB004) and adhered to the principles outlined in the Declaration of Helsinki. Patient recruitment took place in August 2022 among individuals visiting the Department of Refractive at Changsha Aier Eye Hospital. A total of 200 patients, encompassing 400 myopic eyes slated for refractive surgery, were included in the study. Visual acuity testing was conducted using a decimal visual acuity chart, and skilled optometrists measured the patient's refractive parameters. Intraocular pressure was measured using a noncontact tonometer. 2.2 Optomap imaging acquired The Optomap Daytona P200T device utilizes red (635 nm) and green (532 nm) lasers to scan the retina and generate a color image. Initially, the patient's pupils were fully dilated using Tropicamide Phenylephrine Eye Drops (0.5% tropicamide and 0.5% epinephrine, Santen Pharmaceutical). An experienced technician then captured ultra-widefield Optomap images to obtain high-quality visuals. Subsequently, a senior retinal specialist reviewed all the exported pictures. 2.3 90D lens retinal examination Following full pupil dilation, another senior masked retinal specialist employed a 90D lens. All retinal findings and their respective locations were meticulously recorded for subsequent analysis. In this study, the 90D lens examination served as the gold standard for comparative evaluation. 2.4 Statistical analysis In this study, continuous variables such as age and spherical equivalents were summarized using the mean and standard deviation, while categorical variables were presented as frequencies and percentages. Sensitivity and specificity of the Optomap image were calculated by comparing with the 90D lens retinal examination. The Chi-square test was employed to compare the detection rate of retinal lesions between the Optomap image and the 90D lens retinal review. Statistical analyses were conducted using GraphPad Prism 8.0 software, with a p-value < 0.05 considered statistically significant. 3. Results 3.1 Patient characteristics The study encompassed a total of 400 myopic eyes, evenly distributed between 200 right and 200 left eyes, involving 200 patients. Among the participants, 116 (58%) were male, and 84 (42%) were female. The median age was 21.52 ± 3.25 years, ranging from 18 to 41 years. The mean median diopter was − 3.52D ± 1.54, ranging from − 0.5D to -9D. The demographic and ocular characteristics of the patients are detailed in Table 1 . 3.2 Presence of peripheral retinal lesions In the 90D lens retinal examination, 54 out of 400 eyes (13.5%) exhibited peripheral retinal lesions that necessitated treatment before refractive surgery. Ten eyes manifested more than one type of degeneration. Among the 54 eyes, lattice or pigmentary degeneration was the most prevalent retinal lesion, observed in 24 eyes (44.5%), followed by vitreoretinal traction in 18 eyes (33.3%), and retinal holes or tears in 12 eyes (22.2%). In Optomap imaging scanning, 37 out of 400 eyes (9.25%) displayed peripheral retinal lesions, showing no statistical difference (P > 0.05) compared to the 90D lens. The sensitivity and specificity of the Optomap images were 75.9% and 95.31%, respectively. Table 2 provides details on peripheral retinal lesions detected under Optomap versus the 90D contact lens. Figures 1-A, 1-B, and 1-C illustrate retinal holes, lattice generation, and vitreoretinal traction, respectively. In further analysis, the rate of Optomap detecting vitreoretinal traction was lower than that of the 90D lens, displaying statistical significance (P < 0.05). The sensitivity and specificity for detecting vitreoretinal traction with Optomap were 33.3% and 96.95%, respectively. 3.3 Missing areas in Optomap imaging In comparison to the results obtained with the 90D lens, peripheral retinal lesions that were not detected by Optomap imaging were predominantly located in the peripheral above quadrant (7/17, 41.17%), followed by the down quadrant (6/17, 35.2%), nasal quadrant (3/17, 17.64%), and temporal quadrant (1/17, 41.17%). The missing areas in Optomap imaging are visually represented in Fig. 2. 3.4 post-photocoagulation retinal lesions outcome A total of 40 patients underwent prophylactic laser treatment. After 1-month, retinal examinations revealed that their retinal breaks had sealed, and vitreoretinal traction was resolved (Fig. 3). Ultimately, 31 patients proceeded with refractive surgery. No cases of retinal detachment developed following refractive surgery during the follow-up period. 4. DISCUSSION In corneal laser refractive surgery, the microkeratome suction can compress the anterior and posterior segments of the eye, which potentially cause displacement of the vitreous base and lead to the formation of retinal breaks[ 9 ]. Flaxel et al[ 10 ]. found a change in axial length with the removal of the vitreous base, while Brady et al.[ 11 ] reported an incidence of new-onset posterior vitreous detachment (PVD) after LASIK of 9.5%, which PVD was a known risk factor for retinal tears/detachments. As a result, a thorough and meticulous retinal examination is required before preventing postoperative retinal complications. In this study, the incidence of peripheral lesions (13.5%) was lower than in previous studies[ 12 , 13 ]. The difference rate was because we prioritized more peripheral retinal lesions----retinal holes/tears, peripheral lattice or pigmentary degeneration, vitreoretinal traction since those are considered risk factors for retinal detachment. The myopic conus, white without pressure, snowflake degeneration was not included in this study because these lesions generally do not damage vision or have no relationship with retinal breaks. However, these lesions also were included in previous studies. In this study, the sensitivity of Optomap for detecting retinal tears/holes (75%) and lattice or pigmentary degeneration (87.5%) was found to be higher compared to a study by Yang et al[ 14 ]. (57.3%). One possible explanation for this difference could be the adequate pupillary dilatation during Optomap image acquisition, which helps avoid blind peripheral retinal areas. The sufficient pupillary dilatation likely contributed to a higher detection rate of peripheral lesions compared to previous studies where Optomap imaging was done without mydriasis. Additionally, there was no statistical difference in the diagnosis of retinal tears/holes, lattice, or pigmentation between Optomap and the 90D lens. Further analysis revealed that the missing areas in Optomap were primarily located above and below the retinal area, often restricted by eyelids and eyelashes. Using a cotton bud or speculum for eyelid retraction was suggested to enlarge the detected area, improving sensitivity[ 15 ]. Additionally, utilizing software like OptosAdvance, which combines several images into a 220° montage, allows for visualizing 97% of the retina, further enhancing sensitivity. However, the sensitivity rate of Optomap for detecting vitreoretinal traction was very low (33.3%) and showed statistically significant differences (P < 0.05) compared to the 90D lens. There are several possible explanations for this difference. Firstly, the characteristic of vitreoretinal traction is the tractive force between the two interfaces that requires better stereoscopic perception; nevertheless, the Optomap image is flat. Moreover, vitreoretinal traction mostly occurs in the vitreous base around the anterior to equator area, which showed poor quality and resolution at the periphery image, causing peripheral retinal lesions to be missed. In our study, the high specificity of Optomap in detecting overall peripheral retinal lesions was 95.31%, detecting retinal tears/holes 99.48%, detecting lattice or pigmentary generation 99.7%, and detecting vitreoretinal traction 96.95%. The high quality and resolution of Optomap images contribute to the specificity of the diagnosis. In particular, based on Optomap images, ophthalmologists can focus on suspicious retinal areas, saving time in fundus examination, improving work efficiency, and making the experience more comfortable for patients, especially those who cannot endure pupil dilation. There is no universal consensus on which retinal abnormalities require prophylactic laser treatment, as no randomized controlled research provides explicit proof of the efficacy of such treatment. However, some reviews suggest prophylactic laser treatment in certain circumstances[ 16 ], including lattice degeneration, asymptomatic retinal breaks when monitoring is impossible, persistent vitreoretinal traction, horseshoe tears, giant tears, or retinal dialysis. To ensure the safety of the operation, prophylactic laser treatment was applied for retinal breaks, lattice degeneration, and vitreoretinal traction in our study. After obtaining informed consent, 40 patients underwent preventative laser treatment. The retinal specialist reviewed fundus examinations at least four weeks post-photocoagulation to confirm the sealing of retinal breaks and the removal of vitreoretinal traction before corneal laser refractive surgery was performed. This approach helped ensure the safety of corneal refractive surgery. Among the 31 patients who eventually underwent refractive surgery, none developed retinal detachment during follow-up. However, some studies suggest that retinal lesions after corneal laser surgery may not always be correlated with the preoperative location of retinopathy, emphasizing the importance of annual fundus examinations for patients. Limitations of the study The decision not to use the Goldmann three-mirror contact lens examination as the gold standard might introduce a selective bias. The 90D lens examination could potentially miss some fundus lesions located far from the peripheral retina. A prospective randomized study focusing on identifying the specific types of retinal lesions that require prophylactic laser treatment before corneal refractive surgery, with a longer follow-up, would be valuable in addressing these limitations and providing more comprehensive insights into the management of such cases. Conclusions The Optomap imaging technique proves to be a convenient and effective method for screening retinal lesions in refractive surgery patients. However, when it comes to detecting peripheral vitreoretinal traction, especially in areas above or below the peripheral retina, a thorough examination using the 90D lens fundus examination is still necessary. This suggests that while Optomap offers several advantages, a combined approach with traditional examination methods might be essential for a comprehensive assessment of certain retinal conditions. Declarations Author Contributions SL conceived and designed the study. SL and RZ wrote the manuscript. RZ, SL, WC, LL executed the research and acquired and analyzed the data. All authors: contributed to the article and approved the final manuscript. Funding This work was supported by the Natural Science Foundation of Changsha (Grant No. kq2208494), the Scientific Research Project of Hunan Provincial Health Commission (Grant No. C202307027337), and the Scientific Research Foundation of Aier Eye Hospital Group, China (Grant No. AF2204D14). Consent for publication Not Applicable Ethics approval and consent to participate This study was approved by the Changsha Aier's Eye Hospital Institutional Review Board (IRB004) and was following the tenets outlined in the Declaration of Helsinki. Written consent was obtained from all participants. Data availability statement The data used to support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. References Saw SM, Gazzard G, Shih-Yen EC, Chua WH: Myopia and associated pathological complications . Ophthalmic Physiol Opt 2005, 25 (5):381-391. Arevalo JF, Lasave AF, Torres F, Suarez E: Rhegmatogenous retinal detachment after LASIK for myopia of up to -10 diopters: 10 years of follow-up . Graefes Arch Clin Exp Ophthalmol 2012, 250 (7):963-970. Ruiz-Moreno JM, Alio JL: Incidence of retinal disease following refractive surgery in 9,239 eyes . J Refract Surg 2003, 19 (5):534-547. Aras C, Ozdamar A, Karacorlu M, Sener B, Bahcecioglu H: Retinal detachment following laser in situ keratomileusis . Ophthalmic Surg Lasers 2000, 31 (2):121-125. Stino H, Riessland S, Sedova A, Datlinger F, Sacu S, Schmidt-Erfurth U, Pollreisz A: Comparison of two ultra-widefield color-fundus imaging devices for visualization of retinal periphery and microvascular lesions in patients with early diabetic retinopathy . Sci Rep 2022, 12 (1):17449. Silva PS, Cavallerano JD, Haddad NM, Kwak H, Dyer KH, Omar AF, Shikari H, Aiello LM, Sun JK, Aiello LP: Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years . Ophthalmology 2015, 122 (5):949-956. Khandhadia S, Madhusudhana KC, Kostakou A, Forrester JV, Newsom RS: Use of Optomap for retinal screening within an eye casualty setting . Br J Ophthalmol 2009, 93 (1):52-55. Mackenzie PJ, Russell M, Ma PE, Isbister CM, Maberley DA: Sensitivity and specificity of the optos optomap for detecting peripheral retinal lesions . Retina 2007, 27 (8):1119-1124. Mirshahi A, Kohnen T: Effect of microkeratome suction during LASIK on ocular structures . Ophthalmology 2005, 112 (4):645-649. Flaxel CJ, Choi YH, Sheety M, Oeinck SC, Lee JY, McDonnell PJ: Proposed mechanism for retinal tears after LASIK: an experimental model . Ophthalmology 2004, 111 (1):24-27. Brady J, O'Keefe M, Kilmartin D: Importance of fundoscopy in refractive surgery . J Cataract Refract Surg 2007, 33 (9):1602-1607. Venkatesh R, Cherry JP, Reddy NG, Anilkumar A, Sridharan A, Sangai S, Shetty R, Yadav NK, Jayadev C: Inter-observer agreement and sensitivity of Optomap images for screening peripheral retinal lesions in patients undergoing refractive surgery . Indian J Ophthalmol 2020, 68 (12):2930-2934. Liu L, Wang F, Xu D, Xie C, Zou J: The application of wide-field laser ophthalmoscopy in fundus examination before myopic refractive surgery . BMC Ophthalmol 2017, 17 (1):250. Yang D, Li M, Wei R, Xu Y, Shang J, Zhou X: Optomap ultrawide field imaging for detecting peripheral retinal lesions in 1725 high myopic eyes before implantable collamer lens surgery . Clin Exp Ophthalmol 2020, 48 (7):895-902. Cheng SC, Yap MK, Goldschmidt E, Swann PG, Ng LH, Lam CS: Use of the Optomap with lid retraction and its sensitivity and specificity . Clin Exp Optom 2008, 91 (4):373-378. Wilkinson CP: Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment . Cochrane Database Syst Rev 2014, 2014 (9):CD003170. Tables Table 1 Patients’s eyes characteristics Demographic characteristics(n = 200patients) NO.(%)or mean ± SD Age(year) 21.52 ± 3.25 Gender(Male/female) 116(58%)/84(42%) Ocular characteristics(n = 400 eyes) LogMAR UDVA 1.12 ± 0.22 LogMAR CDVA 0.04 ± 0.12 Sphere(D) -3.52 ± 1.54 Cylinder(D) -1.5 ± 0.85 Intraocular pressure (mmHg) 14.58 ± 2.85 Table 2 Optomap imaging detecting peripheral retinal lesions compared with 90D lens examination Types of peripheral retinal lesions No. by 90D lens examination No. by Optomap(Ture Positive/False Positive) Sensitivity (%) Specificity (%) p Retinal holes or tears 12 10(9/1) 75% 99.48% 0.65 Lattice or pigmentary generation 24 22(21/1) 87.5% 99.7% 0.64 vitreoretinal traction 18 9(7/2) 33.3% 96.95% 0.02 * Total 54 41(37/4) 75.9% 95.31% 0.06 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3767813","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":263317151,"identity":"ba189b1c-5d3e-472c-8fd8-b72015e28c51","order_by":0,"name":"Ruiling Zhu","email":"","orcid":"","institution":"Changsha Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ruiling","middleName":"","lastName":"Zhu","suffix":""},{"id":263317153,"identity":"5a00754c-cd1e-4564-8cfa-949a46090f3e","order_by":1,"name":"Wang Cai","email":"","orcid":"","institution":"Changsha Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Cai","suffix":""},{"id":263317154,"identity":"f9f451f3-3cd2-48dc-b12b-32556fa53dc9","order_by":2,"name":"Lijia Luo","email":"","orcid":"","institution":"Changsha Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lijia","middleName":"","lastName":"Luo","suffix":""},{"id":263317155,"identity":"c6f6ff1e-e4a7-4601-8f73-6e8a5a5f2627","order_by":3,"name":"Shengguo Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACPmYGNiiT+QBDApAyYCaghQ2hhS2BSC0McC08BmDKgJDD2NjZnz34uKPWbsPxno8fHlTckzdn5z34gaHGJhq3w3jMDWeeOZ684czZzRIJZ4oNdzbzJUswHEvLbcCthU2at+1YssGN3A0SiW0JCQaHeQwkGBsO49HC/kz6L1hLzuMfif/AWox/4NfCYCbN2FZjB9TCJpHYANZiRsAWHjPJ3rYDCZJnjplZJBxLMNwA1AJk4PYLP//xZxI/2+rs+Y43P775oyZB3uD8GeMbH2pscGqBgsOJqAoS8CsHgTp7wmpGwSgYBaNgxAIAzARXgfT8tygAAAAASUVORK5CYII=","orcid":"","institution":"Changsha Aier Eye Hospital","correspondingAuthor":true,"prefix":"","firstName":"Shengguo","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2023-12-17 15:29:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3767813/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3767813/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49072486,"identity":"7ee5640d-c4a2-44ab-9078-c154fa9c1cf2","added_by":"auto","created_at":"2024-01-02 17:17:42","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":282305,"visible":true,"origin":"","legend":"\u003cp\u003eperipheral retinal lesions in Optomap imaging.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3767813/v1/b106912e8fcd46c8fa7d247c.jpg"},{"id":49072485,"identity":"a3276441-646e-47c9-a629-e83f4904fca4","added_by":"auto","created_at":"2024-01-02 17:17:42","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172755,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of missing peripheral retinal lesions in Optomap imaging\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3767813/v1/ff2c42c8771af82310282e50.jpg"},{"id":49072487,"identity":"62da6600-65e3-4958-a5ef-f374b01080bd","added_by":"auto","created_at":"2024-01-02 17:17:43","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":252192,"visible":true,"origin":"","legend":"\u003cp\u003ePost-photocoagulation retinal lesions\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3767813/v1/dddd80da1c7fa90bc6aabdf3.jpg"},{"id":59832733,"identity":"a80752a4-e856-4a16-8417-5c8e5f7102df","added_by":"auto","created_at":"2024-07-08 07:47:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1496058,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3767813/v1/43a49ec3-38e8-4986-bc65-303b13420ff6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optomap ultrawide field imaging rapid screening peripheral retinal lesions before refractive surgery","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAt present, with the tremendous advancements in corneal refractive surgery, Small incision lenticule extraction (SMILE) and Femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) have been accepted by more and more myopic people. Myopia is not a simple ametropia but can cause some retinal lesions, such as retinal breaks, lattice degeneration, lacquer cracks, macular hemorrhage, and posterior staphyloma[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003csup\u003e1\u003c/sup\u003e. Though the association of refractive surgery with rhegmatogenous retinal detachment (RRD) remains controversial, some reported that the occurrence rate of RRD after refractive surgery is 0.06\u0026ndash;0.25%[\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, a comprehensive fundus examination is necessary before surgery.\u003c/p\u003e\n\u003cp\u003eTraditionally, the Goldmann three-mirror contact lens examination has served as the gold standard for fundus examination. However, its application in examining refractive patients comes with limitations. The procedure necessitates a topical anesthetic and involves close corneal contact, potentially leading to edema or damage to the corneal epithelium. This close contact may also impact the accurate measurement of the corneal topographic map and elevate the risk of infection during surgery. Although the 90D lens for fundus examination has been widely used in refractive patient screening, it also presents limitations, requiring active patient cooperation and consuming a relatively extended period. Particularly during winter and summer vacations, when the number of patients with refractive errors rises significantly, there is an urgent need for a fast, reliable, and convenient method to screen for potential retinopathy.\u003c/p\u003e\n\u003cp\u003eThe Optomap employs an ellipsometer to capture a wide-field, high-quality retinal image spanning over 200 degrees, recording peripheral retinal vision without the need for mydriasis and corneal contact. A skilled technician can obtain high-quality Optomap fundus images in less than 0.4 seconds[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recognizing the advantages of Optomap, it is extensively utilized for screening early diabetic retinopathy[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e], in ocular casualty settings[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e], and for detecting peripheral retinal lesions[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite these applications, few reports have explored Optomap ultrawide field imaging for screening peripheral retinal lesions under mydriasis before refractive surgery. Consequently, this study aims to compare the diagnostic capabilities of the Optomap (Daytona P200T) with the slit-lamp 90D lens under mydriasis during fundus examination. The goal is to evaluate the role of Optomap in swiftly screening retinal lesions among refractive patients.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003e\u003cstrong\u003e2.1 Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study received approval from the Changsha Aier's Eye Hospital Institutional Review Board (IRB004) and adhered to the principles outlined in the Declaration of Helsinki. Patient recruitment took place in August 2022 among individuals visiting the Department of Refractive at Changsha Aier Eye Hospital. A total of 200 patients, encompassing 400 myopic eyes slated for refractive surgery, were included in the study. Visual acuity testing was conducted using a decimal visual acuity chart, and skilled optometrists measured the patient's refractive parameters. Intraocular pressure was measured using a noncontact tonometer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Optomap imaging acquired\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Optomap Daytona P200T device utilizes red (635 nm) and green (532 nm) lasers to scan the retina and generate a color image. Initially, the patient's pupils were fully dilated using Tropicamide Phenylephrine Eye Drops (0.5% tropicamide and 0.5% epinephrine, Santen Pharmaceutical). An experienced technician then captured ultra-widefield Optomap images to obtain high-quality visuals. Subsequently, a senior retinal specialist reviewed all the exported pictures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 90D lens retinal examination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing full pupil dilation, another senior masked retinal specialist employed a 90D lens. All retinal findings and their respective locations were meticulously recorded for subsequent analysis. In this study, the 90D lens examination served as the gold standard for comparative evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, continuous variables such as age and spherical equivalents were summarized using the mean and standard deviation, while categorical variables were presented as frequencies and percentages. Sensitivity and specificity of the Optomap image were calculated by comparing with the 90D lens retinal examination. The Chi-square test was employed to compare the detection rate of retinal lesions between the Optomap image and the 90D lens retinal review. Statistical analyses were conducted using GraphPad Prism 8.0 software, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Patient characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study encompassed a total of 400 myopic eyes, evenly distributed between 200 right and 200 left eyes, involving 200 patients. Among the participants, 116 (58%) were male, and 84 (42%) were female. The median age was 21.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25 years, ranging from 18 to 41 years. The mean median diopter was \u0026minus;\u0026thinsp;3.52D\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54, ranging from \u0026minus;\u0026thinsp;0.5D to -9D. The demographic and ocular characteristics of the patients are detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Presence of peripheral retinal lesions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the 90D lens retinal examination, 54 out of 400 eyes (13.5%) exhibited peripheral retinal lesions that necessitated treatment before refractive surgery. Ten eyes manifested more than one type of degeneration. Among the 54 eyes, lattice or pigmentary degeneration was the most prevalent retinal lesion, observed in 24 eyes (44.5%), followed by vitreoretinal traction in 18 eyes (33.3%), and retinal holes or tears in 12 eyes (22.2%). In Optomap imaging scanning, 37 out of 400 eyes (9.25%) displayed peripheral retinal lesions, showing no statistical difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) compared to the 90D lens. The sensitivity and specificity of the Optomap images were 75.9% and 95.31%, respectively. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e provides details on peripheral retinal lesions detected under Optomap versus the 90D contact lens. Figures\u0026nbsp;1-A, 1-B, and 1-C illustrate retinal holes, lattice generation, and vitreoretinal traction, respectively.\u003c/p\u003e\n\u003cp\u003eIn further analysis, the rate of Optomap detecting vitreoretinal traction was lower than that of the 90D lens, displaying statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The sensitivity and specificity for detecting vitreoretinal traction with Optomap were 33.3% and 96.95%, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Missing areas in Optomap imaging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn comparison to the results obtained with the 90D lens, peripheral retinal lesions that were not detected by Optomap imaging were predominantly located in the peripheral above quadrant (7/17, 41.17%), followed by the down quadrant (6/17, 35.2%), nasal quadrant (3/17, 17.64%), and temporal quadrant (1/17, 41.17%). The missing areas in Optomap imaging are visually represented in Fig.\u0026nbsp;2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 post-photocoagulation retinal lesions outcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 40 patients underwent prophylactic laser treatment. After 1-month, retinal examinations revealed that their retinal breaks had sealed, and vitreoretinal traction was resolved (Fig.\u0026nbsp;3). Ultimately, 31 patients proceeded with refractive surgery. No cases of retinal detachment developed following refractive surgery during the follow-up period.\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eIn corneal laser refractive surgery, the microkeratome suction can compress the anterior and posterior segments of the eye, which potentially cause displacement of the vitreous base and lead to the formation of retinal breaks[\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. Flaxel et al[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. found a change in axial length with the removal of the vitreous base, while Brady et al.[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e] reported an incidence of new-onset posterior vitreous detachment (PVD) after LASIK of 9.5%, which PVD was a known risk factor for retinal tears/detachments. As a result, a thorough and meticulous retinal examination is required before preventing postoperative retinal complications.\u003c/p\u003e\n\u003cp\u003eIn this study, the incidence of peripheral lesions (13.5%) was lower than in previous studies[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The difference rate was because we prioritized more peripheral retinal lesions----retinal holes/tears, peripheral lattice or pigmentary degeneration, vitreoretinal traction since those are considered risk factors for retinal detachment. The myopic conus, white without pressure, snowflake degeneration was not included in this study because these lesions generally do not damage vision or have no relationship with retinal breaks. However, these lesions also were included in previous studies.\u003c/p\u003e\n\u003cp\u003eIn this study, the sensitivity of Optomap for detecting retinal tears/holes (75%) and lattice or pigmentary degeneration (87.5%) was found to be higher compared to a study by Yang et al[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. (57.3%). One possible explanation for this difference could be the adequate pupillary dilatation during Optomap image acquisition, which helps avoid blind peripheral retinal areas. The sufficient pupillary dilatation likely contributed to a higher detection rate of peripheral lesions compared to previous studies where Optomap imaging was done without mydriasis. Additionally, there was no statistical difference in the diagnosis of retinal tears/holes, lattice, or pigmentation between Optomap and the 90D lens. Further analysis revealed that the missing areas in Optomap were primarily located above and below the retinal area, often restricted by eyelids and eyelashes. Using a cotton bud or speculum for eyelid retraction was suggested to enlarge the detected area, improving sensitivity[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, utilizing software like OptosAdvance, which combines several images into a 220\u0026deg; montage, allows for visualizing 97% of the retina, further enhancing sensitivity.\u003c/p\u003e\n\u003cp\u003eHowever, the sensitivity rate of Optomap for detecting vitreoretinal traction was very low (33.3%) and showed statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared to the 90D lens. There are several possible explanations for this difference. Firstly, the characteristic of vitreoretinal traction is the tractive force between the two interfaces that requires better stereoscopic perception; nevertheless, the Optomap image is flat. Moreover, vitreoretinal traction mostly occurs in the vitreous base around the anterior to equator area, which showed poor quality and resolution at the periphery image, causing peripheral retinal lesions to be missed.\u003c/p\u003e\n\u003cp\u003eIn our study, the high specificity of Optomap in detecting overall peripheral retinal lesions was 95.31%, detecting retinal tears/holes 99.48%, detecting lattice or pigmentary generation 99.7%, and detecting vitreoretinal traction 96.95%. The high quality and resolution of Optomap images contribute to the specificity of the diagnosis. In particular, based on Optomap images, ophthalmologists can focus on suspicious retinal areas, saving time in fundus examination, improving work efficiency, and making the experience more comfortable for patients, especially those who cannot endure pupil dilation.\u003c/p\u003e\n\u003cp\u003eThere is no universal consensus on which retinal abnormalities require prophylactic laser treatment, as no randomized controlled research provides explicit proof of the efficacy of such treatment. However, some reviews suggest prophylactic laser treatment in certain circumstances[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e], including lattice degeneration, asymptomatic retinal breaks when monitoring is impossible, persistent vitreoretinal traction, horseshoe tears, giant tears, or retinal dialysis. To ensure the safety of the operation, prophylactic laser treatment was applied for retinal breaks, lattice degeneration, and vitreoretinal traction in our study. After obtaining informed consent, 40 patients underwent preventative laser treatment. The retinal specialist reviewed fundus examinations at least four weeks post-photocoagulation to confirm the sealing of retinal breaks and the removal of vitreoretinal traction before corneal laser refractive surgery was performed. This approach helped ensure the safety of corneal refractive surgery. Among the 31 patients who eventually underwent refractive surgery, none developed retinal detachment during follow-up. However, some studies suggest that retinal lesions after corneal laser surgery may not always be correlated with the preoperative location of retinopathy, emphasizing the importance of annual fundus examinations for patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe decision not to use the Goldmann three-mirror contact lens examination as the gold standard might introduce a selective bias. The 90D lens examination could potentially miss some fundus lesions located far from the peripheral retina. A prospective randomized study focusing on identifying the specific types of retinal lesions that require prophylactic laser treatment before corneal refractive surgery, with a longer follow-up, would be valuable in addressing these limitations and providing more comprehensive insights into the management of such cases.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe Optomap imaging technique proves to be a convenient and effective method for screening retinal lesions in refractive surgery patients. However, when it comes to detecting peripheral vitreoretinal traction, especially in areas above or below the peripheral retina, a thorough examination using the 90D lens fundus examination is still necessary. This suggests that while Optomap offers several advantages, a combined approach with traditional examination methods might be essential for a comprehensive assessment of certain retinal conditions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSL conceived and designed the study. SL and RZ wrote the manuscript. RZ, SL, WC, LL executed the research and acquired and analyzed the data. All authors: contributed to the article and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Natural Science Foundation of Changsha (Grant No. kq2208494), the Scientific Research Project of Hunan Provincial Health Commission (Grant No. C202307027337), and the Scientific Research Foundation of Aier Eye Hospital Group, China (Grant No. AF2204D14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Changsha Aier\u0026apos;s Eye Hospital Institutional Review Board (IRB004) and was following the tenets outlined in the Declaration of Helsinki. Written consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSaw SM, Gazzard G, Shih-Yen EC, Chua WH: \u003cstrong\u003eMyopia and associated pathological complications\u003c/strong\u003e. \u003cem\u003eOphthalmic Physiol Opt \u003c/em\u003e2005, \u003cstrong\u003e25\u003c/strong\u003e(5):381-391.\u003c/li\u003e\n\u003cli\u003eArevalo JF, Lasave AF, Torres F, Suarez E: \u003cstrong\u003eRhegmatogenous retinal detachment after LASIK for myopia of up to -10 diopters: 10 years of follow-up\u003c/strong\u003e. \u003cem\u003eGraefes Arch Clin Exp Ophthalmol \u003c/em\u003e2012, \u003cstrong\u003e250\u003c/strong\u003e(7):963-970.\u003c/li\u003e\n\u003cli\u003eRuiz-Moreno JM, Alio JL: \u003cstrong\u003eIncidence of retinal disease following refractive surgery in 9,239 eyes\u003c/strong\u003e. \u003cem\u003eJ Refract Surg \u003c/em\u003e2003, \u003cstrong\u003e19\u003c/strong\u003e(5):534-547.\u003c/li\u003e\n\u003cli\u003eAras C, Ozdamar A, Karacorlu M, Sener B, Bahcecioglu H: \u003cstrong\u003eRetinal detachment following laser in situ keratomileusis\u003c/strong\u003e. \u003cem\u003eOphthalmic Surg Lasers \u003c/em\u003e2000, \u003cstrong\u003e31\u003c/strong\u003e(2):121-125.\u003c/li\u003e\n\u003cli\u003eStino H, Riessland S, Sedova A, Datlinger F, Sacu S, Schmidt-Erfurth U, Pollreisz A: \u003cstrong\u003eComparison of two ultra-widefield color-fundus imaging devices for visualization of retinal periphery and microvascular lesions in patients with early diabetic retinopathy\u003c/strong\u003e. \u003cem\u003eSci Rep \u003c/em\u003e2022, \u003cstrong\u003e12\u003c/strong\u003e(1):17449.\u003c/li\u003e\n\u003cli\u003eSilva PS, Cavallerano JD, Haddad NM, Kwak H, Dyer KH, Omar AF, Shikari H, Aiello LM, Sun JK, Aiello LP: \u003cstrong\u003ePeripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years\u003c/strong\u003e. \u003cem\u003eOphthalmology \u003c/em\u003e2015, \u003cstrong\u003e122\u003c/strong\u003e(5):949-956.\u003c/li\u003e\n\u003cli\u003eKhandhadia S, Madhusudhana KC, Kostakou A, Forrester JV, Newsom RS: \u003cstrong\u003eUse of Optomap for retinal screening within an eye casualty setting\u003c/strong\u003e. \u003cem\u003eBr J Ophthalmol \u003c/em\u003e2009, \u003cstrong\u003e93\u003c/strong\u003e(1):52-55.\u003c/li\u003e\n\u003cli\u003eMackenzie PJ, Russell M, Ma PE, Isbister CM, Maberley DA: \u003cstrong\u003eSensitivity and specificity of the optos optomap for detecting peripheral retinal lesions\u003c/strong\u003e. \u003cem\u003eRetina \u003c/em\u003e2007, \u003cstrong\u003e27\u003c/strong\u003e(8):1119-1124.\u003c/li\u003e\n\u003cli\u003eMirshahi A, Kohnen T: \u003cstrong\u003eEffect of microkeratome suction during LASIK on ocular structures\u003c/strong\u003e. \u003cem\u003eOphthalmology \u003c/em\u003e2005, \u003cstrong\u003e112\u003c/strong\u003e(4):645-649.\u003c/li\u003e\n\u003cli\u003eFlaxel CJ, Choi YH, Sheety M, Oeinck SC, Lee JY, McDonnell PJ: \u003cstrong\u003eProposed mechanism for retinal tears after LASIK: an experimental model\u003c/strong\u003e. \u003cem\u003eOphthalmology \u003c/em\u003e2004, \u003cstrong\u003e111\u003c/strong\u003e(1):24-27.\u003c/li\u003e\n\u003cli\u003eBrady J, O\u0026apos;Keefe M, Kilmartin D: \u003cstrong\u003eImportance of fundoscopy in refractive surgery\u003c/strong\u003e. \u003cem\u003eJ Cataract Refract Surg \u003c/em\u003e2007, \u003cstrong\u003e33\u003c/strong\u003e(9):1602-1607.\u003c/li\u003e\n\u003cli\u003eVenkatesh R, Cherry JP, Reddy NG, Anilkumar A, Sridharan A, Sangai S, Shetty R, Yadav NK, Jayadev C: \u003cstrong\u003eInter-observer agreement and sensitivity of Optomap images for screening peripheral retinal lesions in patients undergoing refractive surgery\u003c/strong\u003e. \u003cem\u003eIndian J Ophthalmol \u003c/em\u003e2020, \u003cstrong\u003e68\u003c/strong\u003e(12):2930-2934.\u003c/li\u003e\n\u003cli\u003eLiu L, Wang F, Xu D, Xie C, Zou J: \u003cstrong\u003eThe application of wide-field laser ophthalmoscopy in fundus examination before myopic refractive surgery\u003c/strong\u003e. \u003cem\u003eBMC Ophthalmol \u003c/em\u003e2017, \u003cstrong\u003e17\u003c/strong\u003e(1):250.\u003c/li\u003e\n\u003cli\u003eYang D, Li M, Wei R, Xu Y, Shang J, Zhou X: \u003cstrong\u003eOptomap ultrawide field imaging for detecting peripheral retinal lesions in 1725 high myopic eyes before implantable collamer lens surgery\u003c/strong\u003e. \u003cem\u003eClin Exp Ophthalmol \u003c/em\u003e2020, \u003cstrong\u003e48\u003c/strong\u003e(7):895-902.\u003c/li\u003e\n\u003cli\u003eCheng SC, Yap MK, Goldschmidt E, Swann PG, Ng LH, Lam CS: \u003cstrong\u003eUse of the Optomap with lid retraction and its sensitivity and specificity\u003c/strong\u003e. \u003cem\u003eClin Exp Optom \u003c/em\u003e2008, \u003cstrong\u003e91\u003c/strong\u003e(4):373-378.\u003c/li\u003e\n\u003cli\u003eWilkinson CP: \u003cstrong\u003eInterventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment\u003c/strong\u003e. \u003cem\u003eCochrane Database Syst Rev \u003c/em\u003e2014, \u003cstrong\u003e2014\u003c/strong\u003e(9):CD003170.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatients\u0026rsquo;s eyes characteristics\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDemographic characteristics(n\u0026thinsp;=\u0026thinsp;200patients)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNO.(%)or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge(year)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e21.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender(Male/female)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e116(58%)/84(42%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOcular characteristics(n\u0026thinsp;=\u0026thinsp;400 eyes)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLogMAR UDVA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLogMAR CDVA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSphere(D)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCylinder(D)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIntraocular pressure (mmHg)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eOptomap imaging detecting peripheral retinal lesions compared with 90D lens examination\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTypes of peripheral retinal\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003elesions\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo. by\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e90D lens examination\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo. by Optomap(Ture\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003ePositive/False\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003ePositive)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSensitivity\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eSpecificity\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003ep\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRetinal holes or tears\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10(9/1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e75%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e99.48%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.65\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLattice or pigmentary\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003egeneration\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e22(21/1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e87.5%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e99.7%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.64\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003evitreoretinal traction\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e9(7/2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e33.3%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e96.95%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.02\u003csup\u003e*\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e41(37/4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e75.9%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e95.31%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.06\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Optomap, Myopia, Refractive surgery, Peripheral retinal lesions, Prophylactic laser","lastPublishedDoi":"10.21203/rs.3.rs-3767813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3767813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe aim of this study was to assess the effectiveness of Optomap ultrawide field imaging for swiftly screening retinal lesions in individuals who have undergone refractive surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This retrospective study involved 400 eyes from 200 refractive surgery patients. All participants underwent post-dilated Optomap imaging and a 90D lens fundus examination conducted by a retinal specialist. The study focused on peripheral retinal lesions, including retinal holes/tears, peripheral lattice or pigmentary degeneration, and vitreoretinal traction, while excluding conditions like myopic conus, white without pressure, and snowflake degeneration. The 90D lens examination was established as the gold standard. Sensitivity and specificity of Optomap images were calculated and analyzed. The study compared the differences between the two screening methods for retinal lesions, utilizing the Chi-square test for statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Among the 400 eyes, the retinal specialist diagnosed peripheral retinal lesions in 54 eyes (13.5%) through dilated 90D examination and in 37 eyes (10.25%) through Optomap images. The difference between these two methods was not statistically significant (p=0.06). The overall sensitivity and specificity of the Optomap images were 75.9% and 95.31%, respectively. However, there were significant differences in the diagnosis of vitreous adhesion between the two methods (p=0.03).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Optomap proves to be a convenient and effective tool for screening retinal lesions in refractive surgery patients. However, for cases involving peripheral vitreoretinal traction situated above or below the peripheral retina, a meticulous examination with the 90D lens fundus examination is recommended for comprehensive evaluation and accurate diagnosis.\u003c/p\u003e","manuscriptTitle":"Optomap ultrawide field imaging rapid screening peripheral retinal lesions before refractive surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 17:17:38","doi":"10.21203/rs.3.rs-3767813/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"460972af-5f14-4abc-8c81-5833966f3267","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-08T07:39:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-02 17:17:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3767813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3767813","identity":"rs-3767813","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}