Comparison of ultra-widefield retinal imaging modalities in eyes with asteroid hyalosis

• Imaging modality choice is important when evaluating eyes with asteroid hyalosis. • Fundus photography is relatively poor for visualization in this context. • Fundus autofluorescence can effectively visualize the retina through asteroids. • Fundus autofluorescence appears comparable to intravenous fluorescein angiography. Advancements in ultra-widefield fundus autofluorescence (FAF) and limitations in healthcare delivery have challenged the role of intravenous fluorescein angiography (IVFA) as the “gold standard” for evaluating the retina complicated by asteroid hyalosis (AH). The objective was to compare ultra-widefield retinal imaging methods – both non-invasive (pseudocolor fundus photography [CFP] and FAF) and IVFA modalities – in patients with AH. Retrospective, observational, cross-sectional, single-institution study. One hundred and thirty patients identified via billing codes. Same-day, ultra-widefield retinal imaging modality (CFP, FAF, and IVFA) and diagnosis compatible with AH had image quality compared by standardized grading, including sub-analysis with retinal location. Image quality was defined as the degree of retinal image obscuration from asteroids and was independently measured by two researchers. Agreement was calculated based on predetermined definition. Forty-one patients fulfilled criteria. Imaging modality had a statistically significant effect on image quality in patients with AH ( F = 69.4, p < 0.001). The region of the retina imaged also had a statistically significant effect ( F = 2.9, p = 0.021). Tukey’s honestly significant difference test found that image quality was significantly greater in FAF compared to CFP ( p < 0.001), as well as IVFA compared to CFP ( p < 0.001). However, there was no significant difference of image quality between FAF and IVFA ( p = 0.187). These findings suggest that FAF is comparable in image quality to IVFA when generally assessing the retina with ultra-widefield imaging in patients with AH. Ultra-widefield FAF may serve as a reasonable alternative to IVFA for evaluating patients with these vitreous opacities in the appropriate clinical context.