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Ong J, Zarnegar A, Corradetti G, Singh SR, Chhablani J. Advances in Optical Coherence Tomography Imaging Technology and Techniques for Choroidal and Retinal Disorders. J Clin Med 2022; 11:jcm11175139. [PMID: 36079077 PMCID: PMC9457394 DOI: 10.3390/jcm11175139] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Optical coherence tomography (OCT) imaging has played a pivotal role in the field of retina. This light-based, non-invasive imaging modality provides high-quality, cross-sectional analysis of the retina and has revolutionized the diagnosis and management of retinal and choroidal diseases. Since its introduction in the early 1990s, OCT technology has continued to advance to provide quicker acquisition times and higher resolution. In this manuscript, we discuss some of the most recent advances in OCT technology and techniques for choroidal and retinal diseases. The emerging innovations discussed include wide-field OCT, adaptive optics OCT, polarization sensitive OCT, full-field OCT, hand-held OCT, intraoperative OCT, at-home OCT, and more. The applications of these rising OCT systems and techniques will allow for a closer monitoring of chorioretinal diseases and treatment response, more robust analysis in basic science research, and further insights into surgical management. In addition, these innovations to optimize visualization of the choroid and retina offer a promising future for advancing our understanding of the pathophysiology of chorioretinal diseases.
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Affiliation(s)
- Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Arman Zarnegar
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Giulia Corradetti
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, CA 90095, USA
- Stein Eye Institute, David Geffen School of Medicine at the University of California, Los Angeles, CA 90033, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Correspondence:
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Lei B, Zhou M, Wang Z, Chang Q, Xu G, Jiang R. Ultra-wide-field fundus imaging of acute retinal necrosis: clinical characteristics and visual significance. Eye (Lond) 2019; 34:864-872. [PMID: 31554945 DOI: 10.1038/s41433-019-0587-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/02/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate the clinical characteristics of acute retinal necrosis (ARN) with ultra-wide-field imaging (UWFI) and analyse their visual significance. METHODS Clinical and UWFI records of patients diagnosed with ARN at a single centre over 2 years were reviewed. RESULTS In 38 eyes of 35 patients, the clinical manifestations of ARN on UWFI included patchy (12 eyes) or fan-shaped necrotic lesions (26 eyes), retinal arterial obliteration (38 eyes), vitritis (38 eyes), retinal venous haemorrhage (19 eyes), and vitreous haemorrhage (6 eyes). Retinal detachment was associated with the number of retinal quadrants involved (β = 2.145, P = 0.005). LogMAR BCVA at last follow-up was associated with logMAR BCVA at presentation (β = 0.473, P = 0.004) and retinal detachment (β = 0.367, P = 0.020). CONCLUSION UWFI is useful for detecting retinal lesions in ARN, especially peripheral lesions or through opaque media, and provides valuable information concerning visual prognosis.
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Affiliation(s)
- Boya Lei
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Zhujian Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Duisdieker V, Fleckenstein M, Zilkens KM, Steinberg JS, Holz FG, Schmitz-Valckenberg S. Long-Term Follow-Up of Fundus Autofluorescence Imaging Using Wide-Field Scanning Laser Ophthalmoscopy. Ophthalmologica 2015; 234:218-26. [DOI: 10.1159/000439358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/11/2015] [Indexed: 11/19/2022]
Abstract
Aim: To evaluate the variation of peripheral alterations in different retinal diseases over a period of >3 years by using wide-field fundus autofluorescence (FAF) scanning laser ophthalmoscopy (SLO). Methods: A total of 26 eyes from 13 patients (median age 66 years, range 19-80) with age-related macular degeneration and other retinal degenerations were examined. In 2009, the Optos P200CAF prototype and from 2012 onwards, the Optos 200Tx (Optos plc, Scotland) were used for wide-field FAF SLO (excitation 532 nm). Results: The area involvement in outer retinal pathological alterations, such as atrophy and mottling of the retinal pigment epithelium far beyond the vascular arcades, was readily and better visualized within one image frame using wide-field FAF as compared to pseudocolor SLO of the same device. Over time, progression of existing and the development of de novo peripheral lesions were recorded with a concomitant enlargement of central lesions. In two cases (unilateral paravenous pigmented choroidal atrophy and suspected phenocopy of retinal dystrophy), no longitudinal changes of the topographic distribution of peripheral FAF intensities were noted. Conclusions: Wide-field FAF SLO allows the mapping of dynamic changes at the outer retina far beyond the vascular arcades. While its ability to detect and monitor these changes appears to be better than that of pseudocolor imaging, wide-field FAF SLO may not only be helpful to assess more widespread retinal dysfunction, but may also be useful for longitudinal assessments in natural history studies and interventional clinical trials.
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Kolb JP, Klein T, Kufner CL, Wieser W, Neubauer AS, Huber R. Ultra-widefield retinal MHz-OCT imaging with up to 100 degrees viewing angle. BIOMEDICAL OPTICS EXPRESS 2015; 6:1534-52. [PMID: 26137363 PMCID: PMC4467705 DOI: 10.1364/boe.6.001534] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 05/03/2023]
Abstract
We evaluate strategies to maximize the field of view (FOV) of in vivo retinal OCT imaging of human eyes. Three imaging modes are tested: Single volume imaging with 85° FOV as well as with 100° and stitching of five 60° images to a 100° mosaic (measured from the nodal point). We employ a MHz-OCT system based on a 1060nm Fourier domain mode locked (FDML) laser with a depth scan rate of 1.68MHz. The high speed is essential for dense isotropic sampling of the large areas. Challenges caused by the wide FOV are discussed and solutions to most issues are presented. Detailed information on the design and characterization of our sample arm optics is given. We investigate the origin of an angle dependent signal fall-off which we observe towards larger imaging angles. It is present in our 85° and 100° single volume images, but not in the mosaic. Our results suggest that 100° FOV OCT is possible with current swept source OCT technology.
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Affiliation(s)
- Jan Philip Kolb
- Institut für Biomedizinische Optik, Universität zu Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck,
Germany
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich,
Germany
| | - Thomas Klein
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich,
Germany
- Optores GmbH, Nymphenburger Str. 10, 80335 München,
Germany
| | - Corinna L. Kufner
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich,
Germany
| | - Wolfgang Wieser
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich,
Germany
- Optores GmbH, Nymphenburger Str. 10, 80335 München,
Germany
| | - Aljoscha S. Neubauer
- Augenklinik der Ludwig-Maximilians-Universität München, Mathildenstraße 8, 80336 Munich,
Germany
| | - Robert Huber
- Institut für Biomedizinische Optik, Universität zu Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck,
Germany
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich,
Germany
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Lengyel I, Csutak A, Florea D, Leung I, Bird AC, Jonasson F, Peto T. A Population-Based Ultra-Widefield Digital Image Grading Study for Age-Related Macular Degeneration-Like Lesions at the Peripheral Retina. Ophthalmology 2015; 122:1340-7. [PMID: 25870081 DOI: 10.1016/j.ophtha.2015.03.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Our understanding of the relevance of peripheral retinal abnormalities to disease in general and in age-related macular degeneration (AMD) in particular is limited by the lack of detailed peripheral imaging studies. The purpose of this study was to develop image grading protocols suited to ultra-widefield imaging (UWFI) in an aged population. DESIGN A cross-sectional study of a random population sample in which UWFI was introduced at the 12-year review of the Reykjavik Eye Study in Iceland. PARTICIPANTS Five hundred seventy-six subjects 62 years of age or older. METHODS Ultra-widefield (up to 200°) color and autofluorescence images were obtained using the Optos P200CAF laser scanning ophthalmoscope (Optos plc, Dunfermline, Scotland). The images were graded at Moorfields Eye Hospital Reading Centre primarily based on the International Classification for AMD. Macular and peripheral changes were graded using a standardized grid developed for this imaging method. MAIN OUTCOME MEASURES Presence or absence of hard, crystalline, and soft drusen; retinal pigment epithelial changes; choroidal neovascularization (CNV); atrophy; and hypoautofluorescence and hyperautofluorescence were graded in the peripheral retina. RESULTS Of the eyes examined, 81.1% had AMD-like changes in the macula alone (13.6%), periphery alone (10.1%), and both periphery and macula (57.4%). There was no AMD-like CNV or pigment epithelial detachment in the periphery except in those cases in which these clearly originated from the macula. Seven patients had AMD-like atrophy in the periphery without end-stage disease in the macula. One patient with end-stage disease in the macula had normal periphery results on the color images. While analyzing the eyes, we detected pathologic appearances that were very reliably identified by graders. CONCLUSIONS Phenotyping the retinal periphery using the categories defined by the International Classification confirmed the presence of wide-ranging AMD-like pathologic changes even in those without central sight-threatening macular disease. Based on our observations, we propose here new, reliably identifiable grading categories that may be more suited for population-based UWFI.
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Affiliation(s)
- Imre Lengyel
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Adrienne Csutak
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniela Florea
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Irene Leung
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alan C Bird
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Tunde Peto
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
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Flinn JM, Kakalec P, Tappero R, Jones B, Lengyel I. Correlations in distribution and concentration of calcium, copper and iron with zinc in isolated extracellular deposits associated with age-related macular degeneration. Metallomics 2015; 6:1223-8. [PMID: 24740686 DOI: 10.1039/c4mt00058g] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zinc (Zn) is abundantly enriched in sub-retinal pigment epithelial (RPE) deposits, the hallmarks of age-related macular degeneration (AMD), and is thought to play a role in the formation of these deposits. However, it is not known whether Zn is the only metal relevant for sub-RPE deposit formation. Because of their involvement in the pathogenesis of AMD, we determined the concentration and distribution of calcium (Ca), iron (Fe) and copper (Cu) and compared these with Zn in isolated and sectioned macular (MSD), equatorial (PHD) and far peripheral (FPD) sub-RPE deposits from an 86 year old donor eye with post mortem diagnosis of early AMD. The sections were mounted on Zn free microscopy slides and analyzed by microprobe synchrotron X-ray fluorescence (μSXRF). Metal concentrations were determined using spiked sectioned sheep brain matrix standards, prepared the same way as the samples. The heterogeneity of metal distributions was examined using pixel by pixel comparison. The orders of metal concentrations were Ca ⋙ Zn > Fe in all three types of deposits but Cu levels were not distinguishable from background values. Zinc and Ca were consistently present in all deposits but reached highest concentration in MSD. Iron was present in some but not all deposits and was especially enriched in FPD. Correlation analysis indicated considerable variation in metal distribution within and between sub-RPE deposits. The results suggest that Zn and Ca are the most likely contributors to deposit formation especially in MSD, the characteristic risk factor for the development of AMD in the human eye.
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Affiliation(s)
- Jane M Flinn
- Psychology, George Mason University, Fairfax, VA, USA
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Lee HW, Kim HC. A Case of Atypical Acute Retinal Necrosis Observed Using Ultra-Wide-Field Imaging. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.3.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyung Woo Lee
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Chan Kim
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Soliman AZ, Silva PS, Aiello LP, Sun JK. Ultra-wide field retinal imaging in detection, classification, and management of diabetic retinopathy. Semin Ophthalmol 2013; 27:221-7. [PMID: 23163280 DOI: 10.3109/08820538.2012.708812] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Current ultra-wide field (UWF) retinal imaging systems utilize scanning laser ophthalmoscope technology combined with an ellipsoidal mirror to capture up to 200 degrees of the retina in a single image. When compared with mydriatic ETDRS-protocol, 7 standard field photographs and clinical examination, nonmydriatic UWF images appear to have excellent agreement in allowing the detection and classification of diabetic retinopathy (DR), although larger, definitive validation studies are still forthcoming. UWF imaging and angiography allow visualization of peripheral retinal nonperfusion, vascular leakage and neovascularization in patients with DR that may not be captured on 7 standard fields. Prospective randomized controlled trials are needed to evaluate whether modified laser treatment algorithms based on improved visualization of the retinal periphery might improve patient outcomes. Nonmydriatic UWF imaging has potential applications for ocular diabetic telehealth programs, but validation of newer, more portable, and more affordable UWF imaging models is needed.
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Affiliation(s)
- Ahmed Z Soliman
- Beetham Eye Institute and Eye Research Section, Joslin Diabetes Center, Boston, MA 02215, USA
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Abstract
PURPOSE Recent technological advances in fundus autofluorescence (FAF) are providing new opportunities for insight into retinal physiology and pathophysiology. FAF provides distinctly different imaging information than standard photography or color separation. A review of the basis for this imaging technology is included to help the clinician understand how to interpret FAF images. Cases are presented to illustrate image interpretation. METHODS Optos, which manufactures equipment for simultaneous panoramic imaging, has recently outfitted several units with AF capabilities. Six cases are presented in which panoramic autofluorescent (PAF) images highlight retinal pathology, using Optos' Ultra-Widefield technology. Supportive imaging technologies, such as Optomap® images and spectral domain optical coherence tomography (SD-OCT), are used to assist in the clinical interpretation of retinal pathology detected on PAF. RESULTS Hypofluorescent regions on FAF are identified to occur along with a disruption in the photoreceptors and/or retinal pigment epithelium, as borne out on SD-OCT. Hyperfluorescent regions on FAF occur at the advancing zones of retinal degeneration, indicating impending damage. PAF enables such inferences to be made in retinal areas which lie beyond the reach of SD-OCT imaging. PAF also enhances clinical pattern recognition over a large area and in comparison with the fellow eye. Symmetric retinal degenerations often occur with genetic conditions, such as retinitis pigmentosa, and may impel the clinician to recommend genetic testing. CONCLUSIONS Autofluorescent ophthalmoscopy is a non-invasive procedure that can detect changes in metabolic activity at the retinal pigment epithelium before clinical ophthalmoscopy. Already, AF is being used as an adjunct technology to fluorescein angiography in cases of age-related macular degeneration. Both hyper- and hypoautofluorescent changes are indicative of pathology. Peripheral retinal abnormalities may precede central retinal impacts, potentially providing early signs for intervention before impacting visual acuity. The panoramic image enhances clinical pattern recognition over a large area and in comparison between eyes. Optos' Ultra-Widefield technology is capable of capturing high-resolution images of the peripheral retina without requiring dilation.
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Agreement between image grading of conventional (45°) and ultra wide-angle (200°) digital images in the macula in the Reykjavik eye study. Eye (Lond) 2010; 24:1568-75. [DOI: 10.1038/eye.2010.85] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Neubauer AS, Kernt M, Haritoglou C, Priglinger SG, Kampik A, Ulbig MW. Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy (Optomap). Graefes Arch Clin Exp Ophthalmol 2007; 246:229-35. [PMID: 17622548 DOI: 10.1007/s00417-007-0631-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Accepted: 06/14/2007] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To compare the diagnostic properties of a nonmydriatic 200 degrees ultra-widefield scanning laser ophthalmoscope (SLO) versus onsite mydriatic ophthalmologic examination for diabetic retinopathy. METHODS A consecutive series of 51 eyes of 51 patients with different levels of diabetic retinopathy (DR) was examined. Grading of diabetic retinopathy and macular edema obtained on stereoscopic dilated funduscopy by a retina specialist was compared against grading obtained from Optomap Panoramic200 SLO images. All SLOs were performed with an undilated pupil, and no additional clinical information was used for evaluation of the Optomap images by three independent, masked expert graders. RESULTS A total of five images (9.8%) were not gradable due to insufficient quality. Clinically 4 eyes had proliferative diabetic retinopathy (PDR), while 9 had none, 5 mild, 19 moderate and 14 severe nonproliferative diseases (NPDR). Of the gradable 46 images, a clinically significant macular edema (CSME) was present in 28 eyes clinically. On Optomap, all eyes with PDR were detected as being proliferative, and a sensitivity of 94% at a specificity of 100% was obtained for all graders to detect more than mild DR. Agreement between Optomap retinopathy grading and clinical assessment was good with unweighted kappas of 0.68, 0.68 and 0.51. Assessment of CSME yielded sensitivities of 93, 93 and 89% at specificities of 89, 72 and 83%. CONCLUSIONS The Optomap Panoramic200 nonmydriatic images are of sufficient quality to assess DR and CSME validly and therefore fulfill the basic requirements for telescreening programs.
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Affiliation(s)
- Aljoscha S Neubauer
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr 8, Munich, Germany.
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Laser Literature Watch. Photomed Laser Surg 2006; 24:222-48. [PMID: 16706704 DOI: 10.1089/pho.2006.24.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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