Two Methods Improve Peripheral Retinal Lesion Detection in Myopic Eyes

Medical Fundus photo of retinal pathology, diabetic retinopathy
Sensitivity for detecting lesions in the superior and inferior sectors underwent a maximal increase using the eye-steering technique compared with other quadrants.

A combination of using eye-steering and mydriasis during ultrawide field imaging (UWFI) improves the sensitivity of detecting peripheral retinal lesions in patients with myopia, according to findings published in the British Journal of Ophthalmology.

Researchers conducted a cross-sectional, observational study of 220 eyes of 110 patients (mean age 28.08±6.37 years, 75 women, mean spherical equivalent (SE) -8.76±4.24 D) with known peripheral retinal lesions from a single center between 2019 and 2020. Participants underwent non-mydriatic standard, mydriatic standard, non-mydriatic eye-steering, and mydriatic eye-steering UWFI evaluations at nasal, temporal, superior, and inferior gazes, and the team compared the sensitivity of detecting retinal lesions between the 4 approaches.

Overall, 64.09% (n=141) of eyes had peripheral retinal lesions, and 52.73% (n=116) had peripheral retinal holes or tears. A total of 57 eyes (25.91%) had more than 1 type of peripheral pathology and 29.54% had lesions in more than 1 quadrant.

The investigators determined that sensitivity for detecting retinal lesions was 41.84% (95% CI, 33.62%-50.54%) using non-mydriatic standard UWFI settings, 52.48% (95% CI, 44.08%-60.75%) under mydriatic standard setting, 75.18% (95% CI, 67.21%-82.06%) with non-mydriatic eye-steering, and 86.52% (95% CI, 79.76%-91.69%) with the combination of mydriasis and eye-steering. Researchers established a statistical significance for detecting lesions for both mydriasis and eye-steering (P <.001 for both) with the superior and inferior quadrants. 

The team also noted that the eye-steering technique improved sensitivity by 33.33% without mydriasis, and by 34.04% under mydriatic settings. The mydriasis setting increased sensitivity by 10.64% with standard methods and by 11.35% using eye-steering techniques.

Stratified by gaze, the eye-steering technique had a higher sensitivity than the standard technique in non-mydriatic settings for the superior (P <.001), inferior (P <.001), and temporal (P <.01) gazes. Under mydriatic settings, the eye-steering technique was more sensitive than the standard method for superior (P <.001), inferior (P <.001), temporal (P <.05), and nasal (P <.05) gazes.

Stratified by myopia severity, the sensitivity of detecting retinal lesions using non-mydriatic standard UWFI was 38.71% in low to moderate, 41.18% in high, and 42.11% in ultrahigh myopic eyes. Using a combination of the mydriatic setting and eye-steering technique increased sensitivity to 90.32%, 86.76%, and 81.58%, respectively.

“Mydriasis and eye-steering technique could both efficiently improve the sensitivity of detecting peripheral retinal lesions in myopic patients,” according to the researchers. “Lesions of superior and inferior quadrants benefited more from eye-steering technique.”

This study was limited by the small number of specific peripheral retinal lesions, a lack of follow-up image data, and compromised images of the peripheral retina when 3-dimensional images were flattened into 2-dimensional fundus photographs.


Li M, Yang D, Shen Y, et al. Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients. Br J Ophthalmol. Published online March 3, 2022. doi:10.1136/bjophthalmol-2021-319809