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Optos 200Tx and Heidelberg Spectralis EXPERIMENTAL AND THERAPEUTIC MEDICINE 21: 19, 2021 Performance evaluation of two fundus oculi angiographic imaging system: Optos 200Tx and Heidelberg Spectralis SHUANG LI, JING‑JING WANG, HONG‑YANG LI, WEI WANG, MENG TIAN, XU‑QIANG LANG and KANG WANG Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China Received December 15, 2018; Accepted October 29, 2019 DOI: 10.3892/etm.2020.9451 Abstract. The present study aimed to compare the imaging Introduction performance of two ultra‑wide‑field fluorescein angiog‑ raphy imaging systems, namely the OptosOptomap 200Tx Ultra‑wide‑field fluorescein angiography (UWFA) is a novel (Optos 200Tx) and the Heidelberg Spectralis (Spectralis). A total technology that has developed rapidly in recent years (1,2). of 18 patients (36 eyes) underwent angiography using the two As numerous pathological changes of fundus diseases occur systems at the Department of Ophthalmology, Beijing Friendship at the edge of the retina, the limitation of imaging leads to Hospital (Beijing, China) between January and June 2017. The insufficient diagnosis or underestimation of the severity of the images were obtained as a single shot centered on the macula. disease (3,4). Therefore, clear imaging of the edge of the retina The total area and area within each of four visualized quadrants is important for the diagnosis, monitoring and prognostication were calculated and compared. The averages of the total and of patients with ocular fundus diseases. The traditional fundus individual quadrant area captured by the Optos 200Tx were fluorescein angiography system may only provide a vision field all larger than those obtained with the Spectralis (P<0.05). For ranging from 30 to 55 degrees (5). Even with the conventional pair‑wise comparison, the circular area centered on the macula 7 standard field imaging proposed by the Early Treatment (radius of 10 and 15 mm) was displayed: Optos 200Tx 10 mm Diabetic Retinopathy Study, it may only cover the 75‑degree (295.57 mm2) < Spectralis (520.11 mm2) < Optos 200Tx 15 mm fields, which accounts for ~25% of the total area of the retina. (596.45 mm2) < Optos 200Tx (804.36 mm2) (P<0.01). The Thus, it cannot fully display the retinopathy (6,7). By contrast, differences of each of the four quadrant areas were statistically the current ultra‑wide‑angle technology has been able to significant between the two systems (P<0.05). The mean size provide a vision ranging from 100 to 200 degrees (8‑10). In of the areas was in the following order: Inferior < temporal < addition, by using the traditional fundus fluorescein angiog‑ superior < nasal for the Optos 200Tx, and inferior < temporal raphy system, observation and precise measure of structures < nasal < superior for the Spectralis. Further comparison of and lesions around the edge of the fundus may only be the four‑quadrant area indicated that the inferior quadrant of performed through later image reconstruction (11). However, the Optos 200Tx was smaller than the other three quadrants the blood circulation is a dynamic process and there is a time (P<0.01) and the inferior quadrant of the Spectralis was smaller delay in the images captured; therefore, there are certain limi‑ than the superior quadrant (P<0.01). The total retinal area and tations in the observation of the structure of the retina and the retinal area of each quadrant captured by the Optos 200Tx choroid, as well as the blood circulation. were larger than those captured with the Spectralis. The total The current UWFA technology features ultra‑wide‑angle retinal area captured with the Optos 200Tx was able to cover color photography, autofluorescence imaging and fluorescein the mid‑peripheral area and part of the far‑peripheral area of angiography, and all of these have been widely used in the the retina, whereas the Spectralis only covered the mid‑periph‑ observation and research of marginal retinal diseases (1,12). eral area. However, clinical data produced using this imaging tech‑ nology are still limited. By collecting clinical research data, the advantages and disadvantages of UWFA technology may be elucidated, which is key in the interpretation of images and the application of UWFA may be constantly enhanced. This will facilitate the accuracy of the assessment of fundus Correspondence to: Dr Kang Wang, Department of diseases, even under complex conditions. Ophthalmology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng, Beijing 100050, P.R. China At present, the most widely used UWFA devices on the E‑mail: [email protected] market are the 200Tx Optos ultra‑widefield imaging system (Optus) and the Spectralis HRA+ optical coherence tomog‑ Key words: ultra‑wide‑angle imaging, fundus fluorescein raphy (OCT) system (Heidelberg Spectralis) (13,14). These two angiography, Optos 200Tx, Heidelberg Spectralis types of ultra‑wide‑angle fundus imaging device may obtain retinal images in a variety of modes of the posterior pole and the marginal region through non‑contact single photographing 2 LI et al: FUNDUS OCULI ANGIOGRAPHIC IMAGING: Optos 200Tx vs. HEIDELBERG SPECTRALIS without any later image reconstruction (1,15). However, there stereographic projection images using proprietary software are certain different characteristics in imaging between the available from the manufacturer (Doheny Eye Institute) before two systems. On a single non‑steered image, the Optos covers quantitative analysis (16). a larger total retinal area and greater image variability than the Spectralis, while the Spectralis captures the superior and Quantitative analysis method and quality control of FFA inferior retinal vasculature more peripherally (14). To date, images. First, two different modal images of the Spectralis no comprehensive comparative analysis of the two imaging and Optos 200Tx were calibrated and standardized by using systems has been performed. In the present study, macula ImageJ 1.49b software (National Institutes of Health). The retina centered images obtained from a single shot by using the two profiles of the FFA images captured by the two devices were devices, Optos and Spectralis, were analyzed (Fig. 1). The total then respectively depicted by using Adobe® Photoshop CS6 area of the two UWFA images, as well as the retina imaging (Adobe Inc.). Grading results were saved as binary masks and area of the four quadrants, which are nasal, superior, inferior subsequently calculated in square millimeters by summing the and temporal, were compared. The present study provides size of all pixels that make up the mask using the manufac‑ practical information for the clinical application of these two turer's (16) quantification software (Doheny Eye Institute). If systems. the UWFA image was poor, the image quality was improved by adjusting the contrast and brightness, and subsequently, the Patients and methods contour of the image was accurately delineated and measured. The analysis regions included the following: a) Centered on Study design and participants. A single‑center, open‑labeled the macula, the area was evenly divided into four quadrants: prospective cohort study was performed at the Department of Superior, inferior, nasal and temporal; b) centered on the Ophthalmology, Beijing Friendship Hospital, Capital Medical macula, areas with a diameter of 10 and 15 mm. The drawing University (Beijing, China) from January to June 2017. A total process is illustrated in Fig. 2 and 3. The total area and the four of 18 adult patients (36 eyes) were screened for inclusion. The quadrant areas of the contrast images captured with the two inclusion criteria were as follows: Age, ≥18 years; diopter devices were individually calculated. The total area (mm2) of interstitial clear; best‑corrected visual acuity >20/200. The FFA retinal imaging and the captured area of the regions from following exclusion criteria were applied: The eye condition the two devices were compared. changed significantly during the first 3 months after the first fundus examination; retinal detachment and choroidal detach‑ Statistical analysis. SPSS 20.0 software (IBM Corp.) was ment; difficult image acquisition due to poor vision; intolerance used for statistical analysis of the data. Measurement data or poor cooperation with fluorescein fundus angiography (FFA) were expressed as the mean ± standard deviation. For examination; allergy to fluorescein sodium (for injection). comparison between different devices in the same test area, a paired Student's t‑test was used when data conformed to Fluorescein angiography and image selection. For outcome a normal distribution and Wilcoxon's signed‑rank test was evaluation, the total area and area within each of four visual‑ used when data did not conform to a normal distribution. ized quadrants (superior, inferior, nasal and temporal) were The Shapiro‑Wilk method was used to test the normality of calculated and compared. The 200Tx Optos ultra‑wide field distribution of the data. The Friedman test was used to assess imaging system (Optus) and the Spectralis HRA+OCT system differences between directions with the same instrument, and (Heidelberg Spectralis) were used to collect fundus angiog‑ post‑hoc analysis with a paired Student's t‑test or Wilcoxon raphy images. signed‑rank tests was performed with a Bonferroni correction First, allergy to the contrast media was tested by a subcu‑ applied. All tests were bilateral and P<0.05 was considered to taneous test; a specialized technician dilated the pupil for indicate statistical significance. half an hour by using tropicamide phenylephrine eye drops. Subsequently, 1% fluorescein sodium diluent was injected Results and observed to confirm that the patients were not allergic to the contrast media. Subsequently, 5 ml 20% fuorescein Characteristics of the participants. A total of 72 FFA images sodium injection was injected in 5 sec via the elbow vein. from 18 patients (36 eyes) were included in the present For the Spectralis, after capturing a 30‑sec video by using study (Table I), including 11 male cases with 22 eyes and a 102 degrees super wide‑angle front lens, the patients were 7 female cases with 14 eyes.
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