This study was aim to compare the wide-field laser ophthalmoscope with present methods in the fundus examination of myopia before refractive surgery.

104 eyes of fifty-two patients were included in the study before refractive surgery from March 2019 to April 2019 in Beijing Tongren Hospital. All subjects underwent wide-field laser ophthalmoscope, binocular indirect ophthalmoscope an front mirror. The image of wide-field laser ophthalmoscope was taken with the pupil under natural light, two others were examined with mydriasis. The results of three methods were compared and analyzed at last. Meanwhile, the subjective feelings of patients were investigated through questionnaires. The results were compared by paired chi-square test in wide-field laser ophthalmoscope and indirect ophthalmoscope, wide-field laser ophthalmoscope and front mirror, indirect ophthalmoscope and front mirror.

No significant statistical differences were observed in the retinopathy of posterior perioptic choroid atrophy arc, posterior scleral staphyloma, and leopard fundus (χ²=0.00, 0.00, 0.00; P>0.05), (χ²= 0.00, 0.00, 0.00; P>0.05), (χ²= 2.25, 2.25, 0.00; P>0.05). There were also no significant differences in peripheral non-compression white, frost degeneration and depigmentation, Fuchs spot and pigment degeneration, dry retinal hole and retinal detachment, retinal proliferative or vascular membrane (χ²=0.00, 0.08, 0.00; P>0.05); (χ²= 1.50, 3.20, 0.00; P>0.05); (χ²= 0.57, 0.00, 0.10; P>0.05); (χ²= 0.50, 0.00, 0.00; P>0.05); (χ²= 0.25, 0.25, 0.50; P>0.05). There were statistically differences in peripheral retinopathy of retinal protuberance and lattice degeneration between indirect ophthalmoscope and front mirror(χ²=4.17, P<0.05), and no statistically significant differences were observed in the comparison of wide-field laser ophthalmoscope with indirect ophthalmoscope and front mirror(χ²=0.00, 2.29; P>0.05). And the detection rate of wide-field laser ophthalmoscope for the mentioned above lesions was 71.15%. For the patients with low, moderate and high myopia(χ²=1.33, 0.17, 0.00, P>0.05); (χ²= 0.00, 0.00, 0.00; P>0.05); (χ²= 0.25, 2.29, 0.80; P>0.05). There were no significant differences in the number of eye diseases detected between wide-field laser ophthalmoscope and indirect ophthalmoscope, wide-field laser ophthalmoscope and front mirror, indirect ophthalmoscope and front mirror. Wilcoxon sign rank test was used to analyze the total peripheral lesions in each quadrant, and there were statistically significant differences between wide-field laser ophthalmoscope and indirect ophthalmoscope in the inferior nasal quadrant (Z=-2.67; P<0.05), but no statistically significant differences were found in the superior nasal, superior temporal and inferior temporal quadrants(Z=-1.41, -0.83, -0.33; P>0.05). There were statistically significant differences between wide-field laser ophthalmoscope and front mirror in the superior and inferior nasal quadrants (Z=-2.11, -2.07; P<0.05), and no statistically significant differences in the superior and inferior temporal quadrants (Z=-1.67, -0.45; P>0.05). No significant statistical differences were found between the indirect ophthalmoscope and front mirror in four quadrants (Z=-1.00, -0.30, -0.82, -0.73; P> 0.05). The light intensity, patient coordination and overall satisfaction of the indirect ophthalmoscope was 69%(36/52), 88%(46/52), 88%(46/52), which was 53%(28/52), 31%(16/52), 60%(31/52) in the wide-field laser ophthalmoscope and 35%(18/52), 77%(40/52), 75%(39/52) in front mirror. The questionnaires showed that the indirect ophthalmoscope was better than the wide-field laser ophthalmoscope and front mirror in the light intensity, patient coordination and overall satisfaction. Meanwhile, 46%(24/52) patients preferred wide-field laser ophthalmoscope, while both 17% (9/52) patients preferred the indirect ophthalmoscope and front mirror in the report form.

The wide-field laser ophthalmoscope was a convenient and feasible method in the fundus examination before refractive surgery with a high detection rate of myopia related fundus lesions, which had the advantages of avoiding pupil dilation, fast imaging and wide range, and could be used for long-term follow-up. And it is necessary to improve the disadvantages of strong light and difficult cooperation in wide-field laser ophthalmoscope.