Using technology to diagnose retinal holes as a pre-reg

In the practice where I am working, we have an Optomap and optical coherence tomography (OCT). These both provide a method of detailed documentation and are non-invasive, quick, and easy to perform. Both the OCT and Optomap have allowed me to be more confident with the management of patients. Another added value to having these pieces of equipment is that fellow optometrists can present interesting pathology cases for me to learn from. This has enhanced my knowledge of what different pathologies can present as.

Another thing I found useful was when my supervisor, Caoimhe, would show me scans of patients she had that day and would ask for differential diagnosis and how I would manage that patient. Sometimes, I would not have an answer so I would go away and read up on possible causes and management to discuss with her the next day.

The skill of accurately interpreting scans requires practice and experience, which was challenging as these are both things that come with time. Due to the detailed nature of the information provided, I found it best to start off familiarising myself with simpler scans showing healthy eyes, so when I was presented with an abnormal result, I would be able to spot the anomalies more easily.

I also found it beneficial to be able to interpret images for more common ocular complications, for example, dry vs wet age-related macular degeneration, cystoid macular oedema and vitreomacular traction, before expanding my knowledge to more complex cases. As good as technology is, it has its limitations. It was useful to familiarise myself with the limitations of practice equipment, to allow for realistic expectations.

The skill of accurately interpreting scans requires practice and experience, which was challenging as these are both things that come with time

Aiding pathology

I saw a patient a few months ago who had attended for a routine eye examination with no presenting symptoms, so when it came to performing Volk, I was not expecting to see anything abnormal.

However, the patient had two retinal holes in the extreme temporal periphery, one superior and one inferior, with vitreous traction between the two. This was the case in both of her eyes, and was completely unexpected for both the patient and myself.

When I was explaining my findings and management to the patient, I was able to show her exactly what I was talking about. The Optomap proved extremely useful, as it fully documented my concerns and helped me show them to the patient. It also helped me to perform a swift referral.

I referred the patient urgently due to the size of the retinal holes and the accompanying vitreous traction. She returned a few weeks later to update me on the laser the hospital eye service had performed, and was extremely grateful for the services provided.

My practice does not use artificial intelligence currently, however it has been discussed. I think it is something that will be a great tool to improve diagnostics and potentially initiate earlier intervention, as algorithms can be used to aid with early detection of common ocular pathology.

At the time of writing this, I was preparing for my Stage Two assessments, which were both only a few days away. Since then, I have passed both my overarching and direct observation assessments first time. I am now preparing for July OSCES.