Optometrist Christopher Gould reviews why the handheld fundus camera has enhanced his domiciliary practice routine
I have been a full-time domiciliary optometrist in North Wales for the last 10 years. The job can be hugely satisfying, but very challenging.
There are many who claim that the domiciliary eye examination can never be as good as those available on the High Street. I do not agree. I aspire to provide eye examinations for housebound patients that are as comprehensive as tests available in a practice.
Most High Street practices now offer digital retinal photography, but this technology has not been widely available for housebound patients. I felt that this situation was unsatisfactory, and have tried various portable retinal cameras in recent years. The results were a little disappointing. However, when I saw the Zeiss Visuscout at Optrafair last year, and took a fundus photo through a colleague’s undilated pupil in the brightly lit exhibition hall, I was very impressed and decided to add one to the arsenal of equipment I carry with me on home visits.
Several months on, and the Visuscout has become as indispensable as my i-Care and my laptop running TestChart 2000.
"The quality of the images produced is very good indeed, and when I get back to base in the evening I simply place the camera back in its charging cradle and then download the images to my PC"
The quality of the images produced is very good indeed, and when I get back to base in the evening I simply place the camera back in its charging cradle and then download the images to my PC. It is also lightweight and compact.
I have found that it is possible to get good images in approximately 70% of my patients. Obviously this is not possible for all patients; the main issues I face include patients with an inability to keep their eyes still, blepharospasm, dense cataract, and small pupils which are not safe to dilate in the domiciliary situation due to narrow angles and very bright rooms. But in most cases, excellent images can be captured.
I usually dilate where it is safe to do so, but acceptable images can often be obtained without dilation in a dimly lit room and when the other eye is covered.
The rubber bellows keep out most stray light and the camera is intuitive and easy to operate. Like all my equipment, it is important to guard against condensation on the lenses by keeping it warm in my vehicle.
With the arrival of this camera, I can see no good reason why digital retinal photography should not become a routine part of the domiciliary eye exam. Now – where is that portable OCT?