The technologies of ocular imaging modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have progressed remarkably. Of these in vivo imaging modalities, recently advanced OCT technology provides high-resolution images, e.g., histologic imaging, enabling anatomical analysis of each retinal layer, including the photoreceptor layers. Recently developed OCTA also visualizes the vascular networks three-dimensionally, which provides better understanding of the retinal deep capillary layer. In addition, ex vivo analysis using autologous aqueous or vitreous humor shows that inflammatory cytokine levels including vascular endothelial growth factor (VEGF) are elevated and correlated with the severity of macular edema (ME) in eyes with retinal vein occlusion (RVO). Furthermore, a combination of multiple modalities enables deeper understanding of the pathology. Regarding therapy, intravitreal injection of anti-VEGF drugs provides rapid resolution of ME and much better visual improvements than conventional treatments in eyes with RVO. Thus, the technologies of examination and treatment for managing eyes with RVO have progressed rapidly. In this paper, we review the multimodal imaging and therapeutic strategies for eyes with RVO with the hope that it provides better understanding of the pathology and leads to the development of new therapies.

Purpose: This study aims to investigate the factors influencing post-treatment visual acuity (VA) in patients with central retinal vein occlusion (CRVO) with macular edema (ME). Methods: The subjects of this study were patients who visited our clinic from May 2013 to July 2019 and who could be followed up with for at least 12 months. Cases with hemi CRVO were excluded from this study. Factors considered in the evaluation of visual prognosis at the 12 months included initial best-corrected VA, central subfoveal thickness, CRVO subtype (nonischemic, ischemic, or converted from nonischemic to ischemic), time taken for the first treatment, number of anti-vascular endothelial growth factor agent injections, structural changes in the inner and outer retinal layers, and the presence of macular ischemia in a multiple regression analysis. Results: There were 41 patients with 41 eyes, 27 males and 14 females. The mean age of the patients was 70.5 ± 12.2 (mean ± standard deviation) years. The mean VA was 0.544 ± 0.576, 0.456 ± 0.568, and 0.586 ± 0.665 at the initial visit, 12 months later, and time of last observation, respectively. There were no significant differences in VAs observed between the baseline, month 12, and final visit. Multiple regression analysis revealed that the external limiting membrane score at month 12 (p = 0.030), the VA at initial visit (p < 0.001), and the presence of severe macular ischemia (p < 0.001) were the key factors associated with VA at month 12. Moreover, severe macular ischemia was identified as the only factor affecting decimal VA less than 20/200 at the last observation (p = 0.0092). Conclusions: Severe macular ischemia is strongly linked to a poor visual prognosis in patients with ME associated with CRVO.

Background: Ultra-widefield (UWF) images are frequently used for fundus examinations during medical screening. Optos^® generates pseudo-color images using only red and green lasers, which may reduce the visibility of retinal interface lesions. In contrast, Clarus™ incorporates blue light, suggesting potential superiority in epiretinal membrane (ERM) detection. Methods: This retrospective study included 233 patients (408 eyes; 816 UWF images per device) who underwent simultaneous Optos^® and Clarus™ imaging plus optical coherence tomography (OCT) at our institution from March to April 2019. Ten blinded ophthalmologists assessed only the UWF images for ERM presence or absence. Diagnosis was confirmed by fundus examination and OCT. McNemar’s test compared detection accuracy. Results: Clarus™ consistently outperformed Optos^®, with superior sensitivity [median 49% (range 42–70) vs. 14% (4–47); p = 0.002], correct judgment rate [85% (82–90) vs. 78% (44–88); p = 0.010], and lower unassessed rate [6% (2–13) vs. 13% (3–52); p = 0.002]. This superiority held across ERM stages, lens status, and ophthalmologist experience levels. Conclusions: This study demonstrated that Clarus™ significantly outperformed Optos^® in ERM detection accuracy. These results suggest that true-color UWF systems like Clarus™ may be more useful for macular screening in routine practice and health examinations.