Australia is Not Immune to Sight Loss Due to Diabetic Retinopathy

As the number of patients with diabetes worldwide continues to skyrocket, Australia’s current population of 24.6 million people is not immune. As a matter of fact, 1.1 million or 22.4 percent of the population has diabetes. As diabetes increases so does the prevalence of Diabetic Retinopathy (DR) making it the leading cause of visual impairment and preventable blindness in working age people in Australia1.

Lions Outback Vision in Western Australia Route Map

In general, most individuals are not aware how risky DR is to sight loss, therefore it is critical for them to be educated on the risks.  Even if a patient is asymptomatic, they may have early non-proliferative stages of DR which typically shows progressive vascular changes within the retina which usually occurs before any change to vision. Once disease reaches the proliferative stage, vision loss can occur rapidly and can be permanent. Key symptoms of proliferative DR include new abnormal blood vessels on the retinal surface, these new blood vessels are weak and may bleed causing retinal damage or lead to vitreous hemorrhage; this may also be associated with the formation of fibrous scar tissue and can cause retinal detachments.

optomap® ultra-widefield (UWF™) retinal imaging assists eyecare professionals detect, manage, and treat the diseases associated with diabetes. In Australia, optomap UWF imaging provides a cornerstone for an evolving standard of care for the diagnosis, management and treatment of diabetic retinal eye disease. Dr. Dianne Pyliotis of Sydney comments that, “the peripheral retina is most likely where you are going to see early signs of non- proliferative DR, which is why the optomap technology is a ‘no-brainer’”.

As an eyecare professional, providing your patients with the best care practices is vital in monitoring the progression of DR. Patient education is very important in this stage – optomap technology allows eyecare professionals to view and discuss changes in the retina with their patients. Dr Pyliotis believes when a patient can see the changes (or lack thereof) within their retina it can give them the motivation they need to begin to make changes to their lifestyle.

UWF Imaging and Clinical Validation

UWF optomap retinal imaging is performed by a specially designed scanning laser ophthalmoscope (SLO) that generates a high-resolution digital image of 200° (or about 82 percent) of the retina, in a single capture. By comparison, conventional 7 standard field (7SF) ETDRS photographs produce a smaller view (approximately 100°or 30%) of the retina. The SLO simultaneously scans the retina using two low-power lasers (red and green) that enable high-resolution, colour imaging of retinal substructures. Additional UWF imaging modalities which are supported with the technology are; fluorescein angiography (FA), fundus autofluorescence (FAF), and indocyanine green chorioangiography (ICG).

Studies have compared optomap colour images of diabetic retinopathy with the clinical examination, seven-standard field photography2,3. The comparison of UWF with ETDRS has determined the sensitivity and specificity to be in perfect agreement additionally 50% of eyes were found to have predominantly peripheral lesions only visualized by UWF imaging. These lesions have been associated with a nearly 5 fold risk in the progression of DR to proliferative disease.3 optomap colour imaging has been validated in other studies finding sensitivity and specificity to be similar to traditional retinal photographs as well as providing additional information about the health of the peripheral retina. These benefits have been evaluated for DR, AMD, retinal breaks and tears, paediatric retinal disease, myopia, ocular oncology, inflammatory disease and a variety of vascular and inherited retinal disorders4. Validation for use of UWF imaging in telemedicine programs has found nearly double the rate of diabetes and a significant reduction in ungradeables5.

Using UWF Imaging for Detection and Treatment of Diabetic Eye Disease in Indigenous Australians

Indigenous Australians are nearly seven times more likely to develop diabetes than their non-indigenous counterparts6. As with other remote and/or underserved populations, education and availability continue to be common barriers to receiving quality care.  Professor Hugh R. Taylor AC, of the University of Melbourne has created the Roadmap6 to close the gap for vision by 2020. He has highlighted 42 key competencies to close the gap for vision between indigenous and non-indigenous Australians, he says;

“One of the key objectives met was getting the Medicare item number for the MBS 715 health check and retinal examination for people with diabetes in primary care… it is a real game changer.”

In partnership with Lions Outback Vision in Western Australia, Optos is determined to combat these numbers, increase patient education, and assist in this endeavour to save the sight of these peoples. The Lions Vision Van consists of three consulting rooms, filled with specialist equipment including optomap devices and can provide comprehensive eye care for cataracts, trachoma, glaucoma and DR. Each year it completes two circuits of rural Western Australia helping save sight for thousands of Indigenous Australians living in rural and remote communities.

A study on DR in the Kimberley Region, Western Australia found that one in five indigenous people who were tested at the rural sight had DR7. Without the deployment of eyecare health coordinator these cases would have gone undetected and patients could have faced loss of sight.

To find out more about incorporating optomap into your practice or clinic please contact us.

Resources:

  1. Macular Disease Foundation, Australia
  2. Nonmydriatic Ultrawide Field Retinal Imaging Compared with Dilated Standard 7-Field 35-mm Photography and Retinal Specialist Examination for Evaluation of Diabetic Retinopathy. 
  3. Peripheral Lesions Identified on Ultra-wideField Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years. Ophthalmology 2015.
  4. Nagiel et al. Ultra Widefield Fundus Imaging, A Review of Clinical Applications and Future Trends, Retina 2016.
  5. Silva. Identification of Diabetic retinopathy and Ungradable Image rate with Ultra-widefield Imaging in a national Teleophthalmology program. Ophthalmology. 2016.
  6. Vision 2020, Close the gap for vision. University of Melbourne April 2013.

What a Difference a Daytona Makes

The Daytona from Optos captures 200° or 82 percent of the retina in a single ultra-widefield (UWF) optomap® image in less than half a second. The built-in eye-steering technology allows non-mydriatic, visualization and imaging of all quadrants beyond the standard 200° view,1 which can make it a valuable technology in early peripheral pathology detection, timely decision-making and, ultimately, sight preservation.

Daytona, Optos, optomap

Dr. Nicole Kish has been using the Daytona in her Visionworks practice (Norman, OK) for more than a year now and has seen the value of its integration into the practice workflow protocols. With the full support of an Optos account manager, Dr. Kish has been able to incorporate her entire staff into the pre-testing process, which, in turn, reduces clinical “chair time” and increases the time spent talking with patients.2 According to Dr. Kish UWF imaging has supported her ability to identify early peripheral changes in patients suspected of having undiagnosed diabetes.

The educational value of the optomap system was a big selling point for Dr. Kish. She has been able to educate large numbers of patients about their eye conditions, providing them with “…a level of education and images of their own eyes they’ve never seen.”

According to Dr. Kish, optomap images offer a “wow” factor to their patients3, who “…love to see what the inside of their eyes looks like.”

The Daytona is a comfortable and patient friendly device, for patients of all ages, even “…wiggly children.” The auto-capture function allows the operator to focus on the patient during the imaging process – and the ergonomic design of the Daytona facilitates a smooth, comfortable experience for both patient and operator.4

Once images have been captured, the device supports instantaneous image transmission. Dr. Kish appreciates the ability to view images on her cell phone when she is out of the office. If another doctor is seeing one of her patients, they are able to send images directly to her phone, which she can then review and to which she can directly respond. This is a critical and collaborative approach when suspect pathology has been detected and referrals need to be expedited.

The Daytona is a comprehensive, multi-modal imaging system offering optomap color, red-free, and autofluorescence (optomap af), images of the retina. optomap technology is capable of producing accurate, high-resolution images without compromising on quality.5 Dr. Kish is particularly impressed with the “…stellar documentation” that optomap imaging produces. The imaging review software allows enhancement, magnification, and measurements of lesions or areas of interest, and annotations are specific to findings in the retina, negating the need for hand-drawn images and notes in patient records. Making full utility of optomap capabilities allows for complete and extensive documentation of ocular health.

According to Dr. Kish, the Daytona is a practice builder; referrals to their practice have increased since they have integrated the optomap technology. It is a technology that is intuitive to use, requires minimal training – and enhances the patient experience.

Dr. Kish states that the Daytona is an established part of their practice workflow and, speaking on behalf of herself and fellow optometrists, shares, “…we’d never want to practice without it.”

Increase patient flow and practice efficiency in less than half a second, with optomap. Visit our website to learn more!

References

  1. Aaron Werner OD, Tech Spotlight: Optos Ultra-Widefield Imaging Devices. Posted: July 6, 2016, http://www.ophthalmologyweb.com/Tech-Spotlights/188712-Optos-Ultra-Widefield-Imaging-Devices/
  2. 2016 SRC Optos Seminar, https://www.youtube.com/watch?v=ZDpVvZXGfI8
  3. Arboretum Eye Professionals Website, https://arboretumeyepro.com/optomap-retinal-imaging
  4. Optometry Web, Product Overview: The Benefits of Daytona from Optos, http://www.optometryweb.com/1672-Videos/
  5. Jeffry Gerson, OD, Imperatives of the Periphery – Ultra-widefield optomap technology transcends standards for early detection and diagnosis, https://www.aop.org.uk/ot/industry/equipment-and-suppliers/2017/01/30/imperatives-of-the-periphery

November is Diabetic Eye Disease Awareness Month

Diabetic eye disease is a leading cause of blindness and vision loss,1 and, according to the World Health Organization, the incidence of diabetes worldwide is escalating.2 It is estimated that by the year 2035, the number of people worldwide with diabetes will have soared to almost 600 million.3 The National Eye Institute (NEI) reports that there are another 86 million American adults who have pre-diabetes.

November Is Diabetic Eye Disease Awareness Month

Diabetic eye disease describes a group of eye conditions that include diabetic retinopathy (DR), glaucoma, diabetic macular edema and cataracts. DR is often reported as the most common form of diabetic eye disease. It is a serious complication of diabetes mellitus (DM), afflicting one third of all people with the disease, and it is the leading cause of blindness among the working population in the world.4

In its report, “Diabetic Eye Disease Projected to Increase Among U.S. Population,” the NEI states that there are currently 7.7 million people ages 40 and older who have DR, and this number is expected to increase to around 11 million by the year 2030. With advances in technology and medicine, adequate management and regular eye examinations, sight loss associated with diabetes may be prevented in 98 percent of cases.5

Primary interventions in the prevention of sight loss in people with diabetes include regular, effective screening programs to detect diabetic eye disease earlier combined with education to encourage patients to undergo yearly eye examinations. Many clinicians agree that UWF is an important part of these examinations, this was recently highlighted in an article by Dr. Paul E Tornambe where he calls for the integration of ultra-widefield (UWF™) imaging as both a practical and clinical asset to the management of patients with diabetes.6 Given the statistics mentioned above, there is potentially a significant challenge for eye care facilities to provide effective and efficient protocols for screening for diabetic eye disease. UWF continues to evolve to address specific patient requirements, including looking at non-mydriatic imaging alternatives which are also designed to be more time efficient.7 optomap® is clinically proven and its multimodal capabilities place it as a leader in imaging patients with diabetes to support the detection of the diabetic retinopathy.

While technology has been advancing, patients continue to go blind. There are still reports that patients fail to attend their annual eye examinations.8 One of the reasons cited for non-attendance is that some patients are not fully aware of the connection between diabetes and eye disease, often believing that if their eyes are asymptomatic, they need not attend an eye examination.9 Integrating UWF imaging could support an improvement in patient compliance and engagement, educating patients about peripheral findings that they may not detect, but which may need urgent attention if left unchecked.

Diabetic patients may have to submit to multiple instillations of mydriatic drops to achieve full pupil dilation, leaving some patients with discomfort due to light sensitivity. Routinely screening patients using non-mydriatic, UWF imaging technology helps ease this anxiety and may reduce the need for dilation at every visit. The speed, multimodal functionalities, patient-centric considerations and practical benefits have established the optomap as a proven clinical technology in the fight against vision loss. In less than half a second, optomap is able to capture a 200 degree image (up to 82 percent) of the retina through an undilated pupil. From a patient education perspective, the resulting images may serve to provide the patient with a visual representation of the link between their physical well-being and their ocular health.  Clinically, UWF has a proven record as valuable technology in a variety of screening programs. It is the ease with which optomap images are captured,10 annotated, stored and shared that facilitate optimal practice efficiency and resource use.

As this potential diabetic eye disease epidemic looms, there is a clear need to work towards the development of a cohesive partnership between patients and eye doctors. Patient engagement, cooperation, and comfort are key factors to ensuring that diabetic eye disease is detected and treated as early as possible, and optomap imaging technology fully supports this collaboration. The incorporation of ultra-widefield technology to support eye screening protocols and routine workflows has the potential to alleviate the projected increased burden of diabetic eye disease on clinical resources, and it also supports improved patient education, compliance and sight loss prevention in at-risk individuals.

Learn more about the clinical benefits of utilizing ultra-widefield optomap in your practice or clinic.

References

  1. https://www.nei.nih.gov/sites/default/files/nehep-pdfs/GM_DED_drop-in%20article_2014.pdf
  2. http://www.who.int/diabetes/global-report/WHD2016_Diabetes_Infographic_v2.pdf?ua=1
  3. James Kang Hao Goh, BSc, Carol Y Cheung, PhD, Shaun Sebastian Sim, MBBS, Pok Chien Tan, MBChB, Gavin Siew Wei Tan, MBBS and Tien Yin Wong, MD, PhD – Retinal Imaging Techniques for Diabetic Retinopathy Screening. Journal of Diabetes Science and Technology 2016, vol 10(2) 282-294 – DOI:10.1177/1932296816629491 dst.sagepub.com
  4. Yau JWY, Rogers SL, Kawasaki R, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. 2012;35(3):556-564. DOI: 10.2337/dc11-1909.
  5. Nentwich MM, Ulbig MW. Diabetic retinopathy – ocular complications of diabetes mellitus. World Journal of Diabetes. 2015;6(3):489-499. DOI: 10.4239/wjd.v6.i3.489.
  6. Paul E. Tornambe, MD, FACS. Cover Story – Ultra-Widefield Imaging: Advancing the Understanding and Management of Diabetic Retinopathy. Retina Today, April 2015 http://retinatoday.com/2015/04/ultra-widefield-imaging-advancing-the-understanding-and-management-of-diabetic-retinopathy
  7. Liu SL, Mahon LW, Klar NS, et al. A randomised trial of non-mydriatic ultra-wide field retinal imaging versus usual care to screen for diabetic eye disease: rationale and protocol for the Clearsight trial. BMJ Open 2017;7:e015382. DOI: 10.1136/bmjopen-2016-015382.
  8. Fisher MD, Rajput Y, Gu T, et al. Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients with Diabetes, Combined with Patient and Provider Perspectives. American Health & Drug Benefits. 2016;9(7):385-393.
  9. M J E Huber, S A Smith, S E Smith. Mydriatic drugs for diabetic patients. British Journal of Ophthalmology, 1985, 69, 425-427.
  10. David M Brown. Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging. US Ophthalmic Review, 2017;10(1):23-6. DOI: http://www.touchophthalmology.com/articles/advancing-detection-and-management-diabetic-retinopathy-ultra-widefield-retinal-imaging

 

The Role of UWF Imaging in the Effective Management of Non-Infectious Uveitis

Uveitis describes a group of intra-ocular inflammatory conditions, where etiology is diverse and may be characterized by inflammation of the uveal tract or indirect inflammation of adjacent tissues1. In his paper, A Long-Term Game Plan for Non-Infectious Uveitis, Sam S. Dahr, MD, reports that the majority of uveitis cases seen in daily practice are non-infectious and idiopathic in origin. This report estimates that the disease affects approximately 300,000 American adults and 22,000 American children. Of great concern for the young, is the lack of proper treatment in the early stages of the disease, which can be attributed to a poor visual outcome 2.

optomap

A study published in American Journal of Ophthalmology finds disease management
was altered in 48% of uveitis patients when optomap ultra-widefield imaging was used.

Proactive and effective management of non-infectious uveitis relies heavily upon developing a therapeutic strategy and a long-term plan, which may involve systemic therapy, patient counseling, close follow-up, dosing adjustments, combination therapy, and consultation with rheumatologists. In his report, however, Sam S. Dahr, MD, suggests that imaging metrics are “…more powerful than any blood test the rheumatologist can order to monitor response”; positioning ophthalmologists to “… bear the decision-making responsibility for these patients.” Many patients with non-infectious uveitis suffer “…inflammatory breakthroughs during systemic therapy, most of which tend to be fairly mild and treatable with topical, injected or oral steroids.” Having clinically-validated3 and efficient technology, such as optomap®, has a huge part to play in supporting the prompt follow-up and effective treatment in this group of patients.

There is growing evidence to support the value of optomap imaging for the detection of various pathological changes associated with non-infectious uveitis, which may alter patient management. Two independent studies utilizing ultra-widefield (UWF) fluorescein angiography3 (optomap fa) and the autofluorescence (optomap af)4 modalities, respectively, determined that when compared to other imaging techniques and clinical examination, their findings influenced a change in some of their treatment decisions. Using optomap fa along with clinical examination influenced a revision in the treatment plans of almost half of the 43 patients (48 percent) in one study, compared to 7 of 43 patients (16 percent) based on examination and “limited fluorescein angiography.” Reznicek et al. concluded that the non-invasive optomap af modality detects more retinal or chorioretinal involvement and is, therefore, a useful diagnostic and follow-up tool in patients with uveitis. Other studies researching the utility of optomap technology in the management of patients with non-infectious uveitis, including the detection of vitreous haze5 and characterizing other associated retinal pathologies, have found it equally effective[6,7].

Given the prevalence of non-infectious uveitis in children disease detection and establishing a therapeutic strategy as early as possible is critical to reducing vision loss. Attempting to acquire retinal images from children with retinal disease, particularly when using the conventional or small-field imaging devices, has traditionally been difficult. A small study evaluated the value of UWF and the utilization of optomap fa in the pediatric population. Findings indicated that “…not only does including optomap fa reduce the need to bring patients to the operating room, but it also allows visualization of peripheral retina findings that are difficult or impossible with other imaging techniques”8.

optomap technology is an efficacious, clinically proven asset in the follow-up and treatment of all patients with non-infectious uveitis. The value of UWF imaging lies with its outstanding ability to image 82% or 200° of the retina in a single capture, which may be expanded, using it’s multi-capture, auto-montage functionality, which enables up to 220° of the retina to be imaged9. It’s non-contact, fast image capture, offering multiple modalities further support its value as a clinically relevant for the early detection of non-infectious uveitis, assisting in effective treatment management for patients of all ages.

Click here to discover the benefits of optomap (UWF) retinal imaging for your practice or clinic.

References:

  1. Rajen Gupta, Philip I. Murray (2006). Chronic Non-Infectious Uveitis in the Elderly Epidemiology, Pathophysiology and Management. Drugs & Aging July 2006, Volume 23, Issue 7, pp 535–558.
  2. Sam S. Dahr, MD (June 2017). A Long-Term Game Plan for Noninfectious Uveitis: Treatment requires patience and a nuanced approach. http://www.retina-specialist.com/article/a-longterm-game-plan-for-noninfectious-uveitis
  3. Campbell JP, Leder HA, Sepah YJ et al (2012). Wide-field retinal imaging in the management of noninfectious posterior uveitis. Am J Ophthalmol 154:908–911.
  4. Reznicek LSeidensticker FStumpf CKampik AThurau SKernt MNeubauer A. Systematic analysis of wide-field fundus autofluorescence (FAF) imaging in posterior uveitis. Curr Eye Res. 2014 Feb;39(2):164-71. doi: 10.3109/02713683.2013.834938. Epub 2013 Oct 21.
  1. Drew Dickson, Aniruddha Agarwal, Mohammad Ali Sadiq, Muhammad Hassan, Robin High, Quan Dong Nguyen and Yasir J. Sepah. Assessment of vitreous haze using ultra-widefield retinal imaging. Journal of Ophthalmic Inflammation and Infection 20166:35. https://doi.org/10.1186/s12348-016-0105-0
  2. Mesquida MLlorenç VFontenla JRNavarro MJAdán A. Use of ultra-wide-field retinal imaging in the management of active Behçet retinal vasculitis.  2014 Oct;34(10):2121-7. doi: 10.1097/IAE.0000000000000197.
  3. Paula E. Pecen MD, Kathleen F. Petro MD, Kimberly Baynes BSN, Justis P. Ehlers MD, Careen Y. Lowder MD, Sunil K.Srivastava MD. Peripheral Findings and Retinal Vascular Leakage on Ultra-Widefield Fluorescein Angiography in Patients with Uveitis Ophthalmology Retina, Volume 1, Issue 5, September–October 2017, pp 428-434. https://doi.org/10.1016/j.oret.2017.01.016
  4. Kai B. Kang, BA; Matthew M. Wessel, MD; Jianping Tong, MD, PhD; Donald J. D’Amico, MD; R. V. Paul Chan, MD Ultra-Widefield Imaging for the Management of Pediatric Retinal Diseases, Journal of Pediatric Ophthalmology and Strabismus. September/October 2013 – Volume 50 · Issue 5: 282-288. DOI: 10.3928/01913913-20130528-04
  5. https://www.optos.com/en/products/the-benefits-of-optomap/

Home Eye Safety Month and the Value of optomap Technology

A survey conducted by the American Academy of Ophthalmology (AAO) highlighted a significant discrepancy between the perceived versus the actual danger of the home environment being a threat for eye injuries1. The survey determined that fewer than half of the respondents saw the home environment as a potential site for eye injuries, and those that did cited the garden and garage as the most dangerous places. In reality, however, each year it is estimated that 50 percent of all eye injuries occur in the home and most could have been prevented if proper eye protection had been worn2. Sadly, only 35 percent of people surveyed claimed to follow a practice of home eye safety by always wearing eye protection when it was needed.

home eye safety month

50 percent of all eye injuries occur in the home and most could have been prevented if proper eye protection had been worn.

Statistics show that there are several ways that people are at risk of eye injury in their homes. The AAO reported that 125,000 eye injuries occur each year due to accidents involving common household products, such as bleach and oven cleaner. Unprotected eyes are also at risk where there are things that move at high speed, such as debris from yard work, power tools or nails being hammered into hard surfaces and even champagne corks.

In the Eye Injury Snapshot3, key findings showed that certain home eye injuries are common amongst certain demographics:

  1. Three-quarters of those injured were male.
  2. The number of children under the age of 12 who suffered eye injuries had increased by 5 percent above the previous five-year survey average, representing one in five injuries.
  3. Accidental falls were reported to be the leading cause of home eye injury, especially in individuals 60 years of age and older4.

Many Eye Injuries Are Preventable

Eye injury prevention is the key to reducing the risk of injury and sight loss. The AAO and the American Society of Ocular Trauma (ASOT) now recommend that every household have at least one pair of ANSI-approved protective eyewear for use during projects and activities that may present a risk of injury. ANSI-approved protective eyewear is manufactured to meet the American National Standards Institute eye protection standard.

But home eye safety is more than just wearing protective glasses. It is also about maintaining a safe home environment: ensuring that carpets and mats are secure; furniture is safe and stable; and that people are aware of the chemicals in their household products and are ensuring that they are handled with care.

Eye injuries can cause serious vision loss. While many eye injuries are obvious, where pain, light sensitivity, deformity, lacerations or burns are present, some are not. Delaying medical attention puts sight at risk. Once an injury occurs, it is important to respond by seeking immediate help from an eyecare professional. optomap technology can play a role in examining the retina of injured eyes.

In cases of suspected retinal damage, it is recommended that a comprehensive dilated eye examination including optomap, is conducted, especially in cases where a dilated fundus examination is not physically possible, particularly if the eye is too swollen or painful, or if the patient is a child. Utilizing the non-contact, non-mydriatic optomap image – which takes less than one-half second to capture – could facilitate easier access to the retina for a preliminary assessment to be made. Not only would this reduce any further trauma to the patient and their eye, but the 200˚ (82%) ultra-widefield optomap image has the potential to detect critical information which may expedite patient referral and treatment intervention, potentially increasing the chances of preventing sight loss.

To find an eye care professional near you who uses optomap technology, click here.

Sources:

1-2. Eye Injuries at Home – March 2016:
https://www.aao.org/eye-health/tips-prevention/injuries-in-home

3. Survey: Nearly Half of Eye Injuries Occur at Home – July 2009: https://ohsonline.com/Articles/2009/07/07/Survey-Finds-Nearly-Half-of-Eye-Injuries-Occur-at-Home.aspx

4. Make Eye Injury Prevention A Priority – 2016:
http://figgardenoptometry.com/2016/02/10/make-eye-injury-prevention-a-priority/