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This healthy 59YO male was referred for asymptomatic lesions in his right eye.
Optos color RGB imaging shows multiple variably round-to-oval subretinal pigmented lesions scattered throughout the nasal right fundus. These lesions are hypo-autofluorescent.
Learning Points:
Group-type congenital pigmented nevi of the RPE (bear tracks) is a relatively rare congenital condition characterized by well-demarcated, hyperpigmented, flat, variably sized RPE lesions that resemble bear footprints. Histopathologically, these lesions resemble congenital hypertrophy of the RPE (CHRPE), with increased numbers of pigment granules in normal-sized RPE cells. These lesions are benign and cause no visual symptoms.
The major fluorophore in fundus autofluorescence (FAF) is lipofuscin, which is intraliposomal RPE material generated as byproducts of outer segment metabolism. The outer retina overlying these bear track lesions shows varying degrees of atrophy. This leads to less lipofuscin production with hypo-FAF.
Although bear tracks and the typical CHRPE lesions (large, round, unilateral, with depigmented lacunae with age) are not associated with systemic abnormalities, the multifocal, often bilateral and small comet-shaped lesions with FAP are associated with colonic polyps and cancer (Romania et al, Ophthalmology 1992;99:911-913).
Retina. 2026 Aug 1;46(8):1380-1387. doi: 10.1097/IAE.0000000000004857.
Optos UWF imaging: Enhancing standard RG images with filtering techniques improves sensitivity for detecting PDR and NV while maintaining specificity — Retrospective, 30 eyes.
Purpose: To evaluate whether vascular enhancement processing of ultra-widefield fundus camera (UWFC) images improves the diagnostic performance for proliferative diabetic retinopathy (PDR), including sensitivity, specificity, and neovascularization (NV) detection accuracy.
Methods: This retrospective cross-sectional study included 30 eyes of 24 patients with diabetic retinopathy (DR) who underwent UWFC imaging at Kagoshima University Hospital. Two image sets were prepared: original UWFC color images and UWFC images combined with vascular enhancement images generated from green-filtered overlay images using automated filtering techniques, including Gaussian, top-hat, homomorphic filtering, and unsharp masking. Ten ophthalmologists independently assessed both sets to determine NV presence and diagnose PDR. The main outcomes were sensitivity and specificity for PDR diagnosis and accuracy of NV detection, compared between sets using the Wilcoxon signed-rank test ( P < 0.05).
Results: Sensitivity for diagnosing PDR significantly improved from 83.5% ± 9.7% with UWFC images alone to 90.9% ± 8.4% with the combined set ( P = 0.033). Specificity showed no significant difference (70.1% ± 15.3% vs. 66.6% ± 28.2%, P = 0.662). NV detection accuracy improved significantly from 37.9% ± 8.2% to 52.8% ± 9.7% ( P < 0.01).
Conclusion: Combining vascular enhancement with UWFC images significantly improves sensitivity for PDR and NV detection accuracy while maintaining specificity, providing a simple, noninvasive, and practical tool for DR screening.
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