I could not live without...
The benefits of ultra-widefield scanning laser imaging
The Optomap DaytonaI confess there was a steep learning curve at first. There were uncharted pathologies lurking in the retinal periphery I had only ever seen in a Terry Tarrant illustration. Now, my Volk lens is still a staple part of my routine, but the direct ophthalmoscope is decidedly out of favour.
One shot with the Optomap and it’s all there; the thousand-word essay I have not got the time to write, the choroidal naevus recorded forever and there for comparison year-on-year. Admittedly, once I’ve had a good look around the fundus, I do start showing off a bit to the patient. I use the animation to fly through their pupil and explore.
I like that I can educate the patient, show them what I’ve seen, help them understand why the eyes need to be examined regularly; reassure them that they are completely healthy. And, if they ask, there is a juicy bank of pathology images to reinforce the point. Typically, though, people love to see their own floaters.
Capturing a good image
The Optomap Daytona uses a combination of cold light lasers – green to visualise the sensory retina to the RPE and red to show the deeper structures from RPE to choroid – providing a 200-degree view of the fundus in an exposure time of less than 0.4 seconds. Small pupils are no problem; deep set eyes and a strong blink reflex take a bit more skill, but it’s rare not to get a good image. Autofluorescence is useful too. It shows up lipofuscin in the retinal pigment epithelium, making optic disc drusen light up like a beacon. It’s helpful for screening patients on tamoxifen or seeing the functioning and non-functioning parts of the retina in dry AMD.
Of course, the Optomap does make pathology detection so much easier, but it doesn’t tell you what to do with what you’ve found. As Trevor Warburton, clinical adviser to the AOP legal department, has pointed out before: if you’ve taken an image, make sure you look at it thoroughly or that image could be your downfall. However, spot a retinal tear, and you have probably saved that person’s eye.