Prevalence of Incidental Peripheral Findings in Macula Pathologies and their Clinical Relevance

Lisa Nivison-Smith

Abstract

Purpose: Recent evidence suggests several macular diseases are associated with peripheral retina changes. However peripheral findings may be overlooked in these diseases as the clinical focus is on the posterior pole. This study investigated the number and type of incidental peripheral retina findings detected in patients with suspected macula pathology. Methods: The records of 979 patients attending the Centre for Eye Health (CFEH) for a macula assessment between Jan 2014 to Dec 2015 were examined. 554 subjects also had the peripheral retina imaged by ultra-wide-field scanning laser ophthalmoscopy (Optomap) and were included in the study. Reason for referral, findings during examination, diagnosis and recommended management were extracted for all subjects. Subjects with incidental findings were also re-evaluated by two clinicians to determine the recommended management if the incidental findings were absent. Results: Twenty-six percent (143/554) of subjects referred for macula assessment had peripheral findings noted in wide-field images and 73% (105/143) of these findings were incidental. The most common finding was pigmentary changes (59%) followed by vitreo-retinal/retinal findings requiring monitoring (21%), vascular findings (11%), innocuous vitreo-retinal/retinal findings (7%) and urgent vitreo-retinal/retinal findings (7%). Notably, 77% of peripheral findings requiring monitoring or urgent referral were incidental. Peripheral findings were commonly incidental for subjects diagnosed with normal aging changes (100%), epiretinal membrane (95%), CSCR (83%) and AMD (75%). Re-evaluation found only 7.6% of subjects had a different management recommendation in the absence of incidental findings but these changes had significant clinical implications as the majority of subjects were downgraded from tertiary medical referral to routine optometric review. Conclusions: These findings highlight the importance of assessing peripheral retina health in macular pathologies.

Details

Year: 2016

Program Number: 160009

Author Affiliation: n/a

Co-Authors: Rebecca Milston, Jaclyn Chiang, Nagi Assaad, Michael Kalloniatis

Co-Author Affiliation: Centre for Eye Health, Sydney AUSTRALIA, Centre for Eye Health, Sydney AUSTRALIA, Prince of Wales Hospital, Ophthalmology Department, Centre for Eye Health, Sydney AUSTRALIA

Room: 211 AB