Abstract
Background: Optical coherence tomography (OCT) is a leading ocular imaging modality, known for delivering high-resolution volumetric morphological images. However, conventional OCT systems are limited by their narrow field-of-view (FOV) and their reliance on scattering contrast, lacking molecular specificity. Methods: To address these limitations, we developed a custom-built 105(∘) ultra-widefield polarization-diversity OCT (UWF PD-OCT) system for assessing various retinal and choroidal conditions, which is particularly advantageous for visualizing peripheral retinal abnormalities. Patients with peripheral lesions or pigmentary changes were imaged using the UWF PD-OCT to evaluate the system's diagnostic capabilities. Comparisons were made with conventional swept-source OCT and other standard clinical imaging modalities to highlight the benefits of depolarization contrast for identifying pathological changes. Results: The molecular-specific contrast offered by UWF PD-OCT enhanced the detection of disease-specific features, particularly in the peripheral retina, by capturing melanin distribution and pigmentary changes in a single shot. This detailed visualization allows clinicians to monitor disease progression with greater precision, offering more accurate insights into retinal and choroidal pathologies. Conclusions: Integrating UWF PD-OCT into clinical practice represents a major advancement in ocular imaging, enabling comprehensive views of retinal pathologies that are difficult to capture with current modalities. This technology holds great potential to transform the diagnosis and management of retinal and choroidal diseases by providing unique insights into peripheral retinal abnormalities and melanin-specific changes, critical for early detection and timely intervention.