Ultra-widefield Imaging Detects 83% of Peripheral Retinal Breaks

The utility of ultra-widefield imaging (UWFI) in conditions like diabetic retinopathy is well-documented, while its effectiveness for detecting retinal breaks remains debated. Previous studies reported sensitivity varying from 33% to 89%, potentially exceeding 90% with peripheral image steering. Recognizing that existing literature often fails to represent real-world clinical scenarios, a recent study assessed the efficacy of UWFI for identifying peripheral retinal breaks within a diverse patient group at a tertiary care facility. Their findings were published last weekend in the journal Eye.Included in the retrospective observational chart review were patients who had undergone UWFI (Optos California) for peripheral retinal breaks at a referral hospital in Dublin from March 2022 to August 2024. The analysis encompassed 336 peripheral retinal breaks across 275 eyes belonging to 238 patients. Researchers argue that peripheral steered imaging should be considered standard of care for peripheral retinal breaks, as they found this technique can detect more of these cases than orthogonal or auto-montage imaging. The above photos show two examples of the value of steering: (A) Normal-appearing Optos fundus photo in straight-ahead gaze. (B) Steered photo of patient A, looking up to reveal peripheral cystoid degeneration (blue arrow) and white without pressure (white arrow). (C) Normal-appearing Optos fundus photo in straight-ahead gaze. (D) Steered photo of patient C, looking down and out to reveal a shallow inferior temporal retinal detachment (white arrow). Photo: Julie Torbit, OD, and Brad Sutton, OD. Click image to enlarge. The findings revealed that UWFI successfully detected 83% of peripheral retinal breaks overall, with sensitivity rising to 96.9% when peripheral image steering was implemented. Sensitivity varied by retinal quadrant; it was significantly higher for temporal (94.1%) and nasal (82.4%) breaks compared to inferior (65.4%) and superior (52.6%) regions. Additionally, the imaging modality proved most effective at detecting breaks posterior to or at the equator (100% detection rate) vs. those anterior to the equator (71.6%). The most common types of retinal breaks identified were horseshoe tears (56.8%), lattice degeneration (20.8%) and operculated breaks (19%).  For advice on how to make use of ultra-widefield imaging in practice, see this recent feature. The researchers pointed out in their paper that the sensitivity of UWFI in this study for retinal breaks is greater than that reported in some previous studies, which they surmise can likely be attributed to improvements in the imaging hardware and software. They also wrote, “Our study helps confirm some findings regarding UWFI that other authors had suggested, chiefly the significant superiority of peripheral image steering for retinal breaks.”Consistent with findings from other studies, the majority of undetected breaks were located in the superior and inferior meridians, primarily affected by eyelid and eyelash interference. The field of view for Optos UWFI is restricted in this regard, typically covering 170° in the vertical meridian compared to 200° in the horizontal range, the researchers pointed out. “We found that using peripheral image steering allowed these artifacts to be overcome and significantly increased detection rates of breaks in these meridians,” they wrote in their paper, adding that “when orthogonal imaging only is used, significantly more breaks anterior to the equator are missed.” This finding is critical, given that more than half of retinal breaks in this study (54.5%) were located in this region.Considering these results, the study authors concluded, “We recommend that peripheral image steering should be considered standard of care for peripheral retinal breaks,” while cautioning that the screening tool “does not obviate careful, dilated clinical exam.”Click here for the journal source. McGrath R, Neary S, Brennan I, Kilmartin D. Sensitivity and utility of ultra-wide field imaging for the detection of peripheral retinal breaks in a large Irish tertiary referral centre. Eye. September 20, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.