Ultra-widefield OCT-A Proposed as Lattice Degeneration Detection Adjunct

A recent study suggested that UWF OCT-A should be positioned as a supplement to, not replacement for, OCT for peripheral lattice degeneration cases. Its value lies in capturing tiny lesions within comparable scan ranges, and this advantage becomes useful only when OCT results are inconclusive. The above scan from the study shows localized retinal thinning on UWF OCT-A. Photo: Cai C, et al.  Int Ophthalmol. 2025;45(1):457. Click image to enlarge. Early identification of vitreous traction and retinal ruptures in lattice degeneration areas is crucial for assessing whether any preventive treatments, such as laser photocoagulation, are necessary. Conventional OCT equipment uses relatively large intervals between scan lines, potentially missing small holes and certain lesion details. In contrast, ultra-widefield (UWF) OCT angiography (OCT-A) offers denser scan lines, enabling the capture of more comprehensive lesion details and compensating for this limitation. In a recent study, researchers in China characterized retinal and vitreous morphological changes in peripheral lattice degeneration using UWF OCT-A guided by scanning laser ophthalmoscope (SLO) and helped provide illustrative clinical applications.“UWF OCT-A enables comprehensive visualization of anatomical structures in peripheral lattice degeneration and captures subtle details (e.g., tiny retinal holes) that may be missed by SLO or OCT,” the study authors wrote in their paper, which was published in International Ophthalmology.In 15 eyes from 15 patients with peripheral retinal lattice degeneration, peripheral lattice lesions were localized by SLO, followed by OCT and UWF OCT-A to evaluate retinal and vitreous changes. After consulting with the patients, OCT-A examinations were also conducted on those patients who had positive results from OCT. In clinical practice, UWF OCT-A is mainly performed when the OCT results are unclear or the technology is insufficient.Five clinical cases helped demonstrate that UWF OCT-A may detect lesion details missed by OCT. In two cases, OCT and UWF OCT-A revealed anatomical details of the retina and vitreous that were not visible in the SLO, including significant vitreous traction, retinal thinning, extensive retinal ruptures and subretinal fluid accumulation. In another, OCT and UWF OCT-A revealed another lesion area in temporal inferior retina that was unsuspected in SLO, along with evident U-shaped vitreous traction, retinal thinning, retinal rupture and subretinal fluid accumulation.“This study is exploratory, with a small sample size and a lack of long-term outcome data, which reflects its focus on clinical observation rather than formal diagnostic validation. The selection of cases was based on clinical needs, introducing selection bias that might overestimate its utility,” the researchers emphasized. “Therefore, it is currently not possible to conclude that UWF OCT-A can guide the decision-making for preventive laser treatment. It mainly proposes a hypothesis that UWF OCT-A may help increase the detection rate of high-risk lesions.”They also noted that standardized lesion grading systems would enhance objectivity, but current challenges include dynamic scan range adjustments and random detection of sub-millimeter holes (dependent on scan line spacing).Click here for the journal source. Cai C, Liu P, Wei Q, et al. Application of ultra-widefield optical coherence tomography angiography in detecting peripheral lattice degeneration. Int Ophthalmol. 2025;45(1):457.  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.