Ultra-widefield fundus imaging (UWFI) is a relatively new technology capable of capturing 200° images of the retina. Since vision changes can be irreversible in diabetic retinopathy (DR), recognition of prognostic biomarkers in the peripheral retina may prove invaluable toward optimizing the management and reducing the societal burden of this blinding disease. Following a bibliographic review using Pubmed, OVID Medline, Embase, and the Cochrane Library, the current review systematically examined 13 studies that compared UWFI to conventional screening techniques such as seven standard field (7SF) Early Treatment In Diabetic Retinopathy Study (ETDRS) and non-mydriatic multifield fundus photography (NMFP), as well as their scientific level of evidence. Overall, UWFI had good agreement with 7SF ETDRS and NMFP, and moderate agreement with dilated fundus examination. Seven additional studies were examined that considered the significance of peripheral lesions found on UWFI. These studies demonstrated that UWFI captured additional DR pathology in the peripheral retina that may not be evident if evaluation is limited to the posterior pole and may be relevant to patient outcomes. Future directions include but are not limited to the potential of UWFI to track the progression of DR with treatment.
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