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/

Athletes and the Eye: Eye Injuries and Using the Retina to Detect Systemic and Ocular Pathology and Disease

Athletes of all levels need to protect themselves from injury. Injuries are unfortunately a part of playing sports – anyone from weekend warriors to professionals, has probably nursed some sort of injury. In some cases, these injuries happen directly to the eye, from orbital blowout fracture, ruptured globe, or a detached retina and some can be detected, along with other types of ocular and systemic pathology, by looking at the health of the eye.

optomap, sports related injury

Both retinal trauma and detachments are not uncommon in sports-related injury. Utilizing optomap during detection and treatment can be particularly useful.

There have been, and continue to be, many studies in the area of sports-related eye trauma. And with more and more interest in the effects of concussions on athletes, seeing “inside” the eye is becoming increasingly important. An x-ray, MRI, CT scan will tell you if something is broken and may confirm a diagnosis of concussion. But what about the effects of repetitive concussive injury? Can that be detected by imaging the eye itself? According to the Centers for Disease Control, up to 3.8 million sports-related concussions occur each year. And detecting these injuries is not always straightforward or based exclusively on objective signs and symptoms. Or what about treating the whole athlete and monitoring systemic as well as ocular health?

Because the retina is the only place in the body where vasculature can be viewed non-invasively, eyecare professionals are looking to the retina to assist them in identifying, diagnosing, and treating ocular and systemic disease in athletes.  With the addition of advanced eye testing, in some cases, ground-breaking discoveries have been made on diseases that have only been able to be identified posthumously, such as chronic traumatic encephalopathy1.

Using retinal images to ascertain overall athlete health is also important. Using images, such as optomap ultra-widefield retinal images, can assist detection of systemic disease as well as ocular disease.

Focus on Sports Vision

What makes a doctor decide to focus on sports vision as a specialty? In a recent interview with Dr. Bronson Hamada of Surf City Optometry of Huntington Beach, CA he explains how he came to his decision to dedicate himself and his practice to the specialty of sports vision.

Tell us more about your passion for helping athletes reach their full human athletic potential. Why did you decide to specialize in athletes? 

As a collegiate athlete, I had Olympic aspirations, but I thought that being a competitive athlete and pursuing a professional degree were mutually exclusive pursuits. So I chose optometry, not knowing that there was a way to combine my passion for sports with professional eye care. In other words, I thought I’d be spinning dials and selling eyeglasses, but now I handle visual performance for several US National Teams, universities, and a host of professional athletes. I am dedicated to helping athletes of all levels achieve their athletic goals by helping them see better and by training them to use their eyes more effectively.

However, when focusing on these elite athletes it is imperative to remember that they use their eyes differently than recreational athletes. I consider sports vision training to be applied vision therapy, so we’ve gone full circle; back to the basics. It’s the same fundamental vision skills, but the patient is now in motion and processing multiple tasks and facing a dynamic, interactive playing field. The good news for our profession is that coaches, trainers, and athletes are seeking our specialized services – athletes to gain even a slight advantage and coaches and trainers for general eye health and athlete investment.

How do you treat ocular and systemic disease and pathology with your innovative eyecare solutions as part of your comprehensive vision test for athletes?

We are always mindful of their goals, health and personal issues, and motivation. I look at each athlete holistically, without judgement, and work to earn their trust. It is important to remember that ocular and systemic disease can affect anyone, and athletes are no different. Training and competing with those afflictions can be a challenge at any level. One of our athletes that recently retired from international competition had Sjogren’s Syndrome and Lupus.

Here is an example of an innovative eye care solution for an Olympic Champion that suffered a traumatic eye injury. This is an excerpt from an email he sent, “I had a big facial injury and reconstructive surgery and now I am having some vision impairment. There were six facial fractures in total. I will be here (Russia) this entire week and then on to the World Cup (Japan) for Olympic qualification. I am recovering and playing and seeing some vision impairment that is intimidating and affecting my performance…ready to aggressively try and fix it. Hope you are up for it.”

We compared baseline and post traumatic vision assessments and looked for opportunities where we could make the biggest impact. We evaluated ocular health (including retinal evaluation) and eye function and then developed a sports vision training plan with less than one week before World Cup. I had no idea what kind of shape he would be in when he arrived, so I concentrated on eye-hand coordination, timing, eye tracking with smooth pursuit and saccadic eye movements, central and peripheral vision, and depth perception, among other treatments. Next we loaded the skills training with strobe glasses. Within a few days, his vision skills improved – more importantly, he gained confidence. We put together a vision training kit for him to take on the road. Later that season, his professional team in Russia won the Champions League Finals, and he represented Team USA at the London Olympics.

How does optomap fit into your treatment plan?

We had a complete paradigm shift! Our initial thought was that optomap was a shiny, nice-to-have, device but we were concerned that our patients would balk at the extra fee. My staff believes in the technology, presents it with enthusiasm and this translates into a tremendous capture rate that helps our bottomline. Many patients avoid routine eye care simply because they dread the dilating drops and don’t want to be “visually impaired” for 3+ hours. Very quickly we began to appreciate the power of optomap for pathology detection and management. optomap is now an indispensable technology, and I can’t imagine practicing without it. I consider optomap the new “Gold Standard” of care for retina evaluation of athletes. We have greater patient satisfaction, save valuable clinical time, generate referrals, and have peace of mind in knowing that we didn’t miss anything.

In addition, the very first day the device was installed, we had a professional athlete that got hit in the face with a ball during practice. The optomap revealed peripheral retinal hemorrhages. Talk about a shift!

In another case, an athlete had an “8 Ball” hyphema and received hydrocortisone IV, and retinal surgery while hospitalized in Germany. With optomap, I am able to get an extensive view of the retina before even stepping into the exam room to monitor and treat any ongoing pathology and determine overall eye health.

Do you consult with other doctors in the area to offer a comprehensive line of care for these athletes?

There are many pieces to the athletic performance puzzle. Optometry and sports vision care are definitely multidisciplinary, so a referral network of trusted specialists is crucial. With athletes of any ability, it is inevitable that as a healthcare provider you will encounter TBI, concussion, and ocular injury. Unfortunately, we see high school athletes that have suffered multiple concussions. Coaches and trainers rely heavily on our judgement for “return to play” decisions. So the more information we have, the better the recommendation we can make. Any significant anterior segment injury can have posterior segment consequences.

Many of the athletes that I care for are extremely tall. Cardiologists and geneticists refer several athletes every year to rule out Marfan’s Syndrome2. This systemic disease can have fatal consequences. Some of the lesser known ocular manifestations of Marfan’s Syndrome are strabismus, myopia, glaucoma, retinal tears, and retinal detachment, so optomap is routinely ordered.  Optos devices have been used in the clinical environment for detection of retinal pathology specifically for Marfan’s Syndrome.

For doctors such as Dr. Hamada, focusing on sports vision, and working with a team of specialists for overall athlete health and wellbeing, has been quite rewarding. By incorporating technology such as optomap, he and the entire team at Surf City Optometry, are also able to see more and treat more of the retina, thereby providing an even higher standard of care.

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References: 

  1. http://www.omicsonline.org/open-access/retinal-and-balance-changes-based-on-concussion-history-a-study-of-division-football-players-2329-9096.1000234.php?aid=31804
  2. Retinal Disease in Marfan Syndrome: From the Marfan Eye Consortium of Chicago Safa Rahmani, MD; Alice T. Lyon, MD; Amani A. Fawzi, MD; Irene H. Maumenee, MD; Marilyn B. Mets, MD

September is Sports Eye Safety Month – Utilizing optomap to Detect, Manage, and Treat Sports-related Eye Injuries

Sports-related eye injuries often result in vision loss, and are the leading cause of blindness in children.1 According to the National Eye Institute (NEI) and the National Eye Health Education Program (NEHEP), in the United States, sports-related eye injuries account for over 100,000 physician visits per year at an estimated cost of $175 million. Since most eye injuries are preventable, more sight may be preserved by exercising injury prevention techniques.

sports eye safety

Protective eyewear is vitally important in the prevention of injury.

Protective eyewear is vitally important in the prevention of injury, but the NEI and NEHEP also strongly recommend that all people who participate in sporting activities have comprehensive eye exams as part of their regular physical examinations, especially for those with pre-existing eye conditions. optomap® has a huge part to play in facilitating difficult eye examinations, and in supporting the early detection of peripheral retinal complications following sports-related eye injuries.

Direct, blunt force injury to the eye often causes swelling for several days, making a comprehensive retinal examination difficult. Early assessment of the eye is imperative in saving sight, as these injuries cause a high risk of retinal detachment or retinal bleed. The half-second capture speed and non-mydriatic advantages of optomap technology allow for more timely, less invasive access to the retina. As long as the pupil can be seen, optomap ultra-widefield (UWF) imaging has the ability to produce a 200° (82%), detailed clinical record of the retina. Not only would this be less painful and less stressful for the patient, but it would provide excellent data for prompt specialist referral, if required.

Not all sports-related eye injuries are immediately apparent to the patient; but if left undetected, they can lead to blindness.2 In these situations, optomap imaging is critical in detecting subtle damage, such as retinal holes or tears in the periphery. optomap technology supports improved patient outcomes, and is invaluable in supporting the early detection, intervention and management of sports-related eye injuries.

Protect your vision – find out more about the benefits of optomap ultra-widefield retinal imaging.

Sources:

  1. National Eye Institute and National Eye Health Education Program (2017) Sports-Related Eye Injuries – What You Need to Know and Tips for Prevention https://www.mja.com.au/journal/2014/201/2/childrens-protective-eyewear-challenges-and-way-forward
  2. Susanne Medeiros and Beatrice Shelton (2017) Sight-Threatening Injury Turns Teenager into Sports Eye Safety Advocate, https://www.aao.org/eye-health/patient-stories-detail/angellia-retinal-detachment Sight-Threatening Injury Turns Teenager into Sports Eye Safety Advocate

UWF Imaging May Boost Early Detection of Choroidal Nevi

It is estimated that in the United States, choroidal nevi can be found in 4.6 to 7.9 percent of Caucasian individuals1 and that one in approximately 8,000 of these nevi transform into melanoma2. It is this rare ability that makes these lesions clinically significant.

Many pathologies, including choroidal nevi and melanoma can be detected and monitored by eyecare professionals with optomap.

Choroidal nevi are typically discovered during routine dilated fundus examinations and are usually asymptomatic. However, some may be associated with central and peripheral vision loss secondary to subretinal fluid, cystoid retinal edema or, rarely, neovascularization3. Choroidal melanoma also tend to be asymptomatic, but are more likely to be symptomatic than benign nevi, presenting as decreased vision, flashes or floaters.

In their study, Cheung et al. suggest that there are phenotypical markers and environmental risk factors that predispose a person to developing choroidal melanoma. A later study4, using optomap®, determined that choroidal nevi were also present in subjects who did not conform to a particular phenotype. Gordon-Shaag et al. concluded that it was the expanded view (200°) of ultra-widefield (UWF™) technology that improved their ability to locate nevi. This was further supported by Brett et al., who concluded that the optomap was the most effective device for pinpointing choroidal nevi5.

Historically, the challenge has been to locate the small melanoma among a cluster of choroidal nevi, since some of their features overlap, including tumor size; color, which may be pigmented or non-pigmented; location; associated quiescent features, such as overlying retinal pigment epithelium (RPE) alterations and drusen; and suspicious features, including subretinal fluid (SRF) and orange pigment.

In a study with 49 patients (29 had established melanoma and 20 had established non-malignant nevi), Kernt et al.6 investigated the imaging properties of clinically diagnosed melanocytic choroidal tumors using a UWF scanning laser ophthalmoscope with two wavelengths to distinguish between benign and malignant tumors. All patients underwent clinical examination, undilated optomap imaging, standardized ultrasound (US) examination and standard retinal photography. They found that typical malignant lesions appeared dark on the red laser channel and bright on the green laser channel. These characteristics, alone, yielded a diagnostic sensitivity of 70 percent and specificity of 76 percent. When other diagnostic findings were considered — lesion size, margin touching the optic disc, and existence of SRF — results improved to 90 percent sensitivity and 82 percent specificity. The authors acknowledge that the addition of other parameters may increase diagnostic accuracy and that larger studies need to be done to validate these findings.

There is growing evidence to support the use of the optomap for routine annual ophthalmic exams for early detection of choroidal nevi. Once identified, they can be recorded and closely monitored for signs of transformation. With regular follow-up, optomap facilitates a full range of investigations to provide eyecare professionals with the relevant information to devise an effective and timely treatment plan.

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Sources:

  1. Singh AD et al. Ophthalmology. 2005:112 (10):1784-1789 cited in Albert Cheung, Ingrid U. Scott, MD, MPH, Timothy G. Murray, MD, and Carol L. Shields, MD – Edited by Ingrid U. Scott, MD, MPH and Sharon Fekrat, MD – Distinguishing a Choroidal Nevus From a Choroidal Melanoma. 2012. EyeNet Magazine. https://www.aao.org/eyenet/article/distinguishing-choroidal-nevus-from-choroidal-mela
  2. Carol L. Shields, MD; Minoru Furuta, MD; Edwina L. Berman, BS; et al. Jonathan D. Zahler, MD; Daniel M. Hoberman, BS; Diep H. Dinh, BS; Arman Mashayekhi, MD; Jerry A. Shields, MD Choroidal Nevus Transformation Into Melanoma Analysis of 2514 Consecutive CasesArch Ophthalmol. 2009; 127(8):981-987. doi:10.1001/archophthalmol.2009.151
  3. Albert Cheung, Ingrid U. Scott, MD, MPH, Timothy G. Murray, MD, and Carol L. Shields, MD – Edited by Ingrid U. Scott, MD, MPH and Sharon Fekrat, MD – Distinguishing a Choroidal Nevus From a Choroidal Melanoma. 2012. EyeNet Magazine. https://www.aao.org/eyenet/article/distinguishing-choroidal-nevus-from-choroidal-mela
  4. Gordon-Shaag A , Barnard S, Millodot M, Gantz L, Chiche G, Vanessa E, Ruth W, Pinchasov R, Gosman Z, Simchi M, Koslowe K and Shneor E. Prevalence of choroidal naevi using scanning laser ophthalmoscope. Ophthalmic Physiol Opt2014; 34: 94-101. doi: 1111/opo.12092
  5. Paul Brett J1, Lake A2, Downes S1,3.J Vis Commun Med. Colour imaging in the monitoring and documentation of choroidal naevi. Are Optomap colour images adequate for this purpose? 2016 Jan-Jun; 39(1-2):10-7. doi: 10.1080/17453054.2016.1182476. Epub 2016 Jun 2.
  6. Marcus Kernt, Ulrich C Schaller, Carmen Stumpf, Michael W Ulbig, Anselm Kampik, and Aljoscha S Neubauer (2010) Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap) Clin Ophthalmol. 2010; 4: 829–836.

 

Use of UWF Imaging During Routine Eye Exams May Increase the Early Detection of Choroidal Nevi

Choroidal nevi are commonly reported as incidental findings in asymptomatic patients during routine eye exams. Nevi on the retina, similar to “freckles” on the skin, should be monitored for changes as they may turn in to melanoma1.

Use of UWF Imaging During Routine Eye Exams Increases the Early Detection of Choroidal Nevi

With the increased use of ultra-widefield (UWF™) imaging, reports of secondary findings of choroidal nevi are increasing. Because optomap®, captures up to 82% or 200° of the retina in a single image, it can impact the ability of eyecare professionals to detect previously unnoticed retinal anomalies. Once found, these anomalies may be closely monitored and differentiated using the optomap 3-in-1 color depth imaging in conjunction with optomap af, the latter which highlights lipofuscin in the retinal pigment epithelium (RPE) and is particularly useful for the detection of choroidal neoplasms and nevi2.

Dr. Bryan Stoller reported using optomap to monitor Jeffry, a 54 year-old man with glaucoma3. Jeffry had his intra-ocular pressure (IOP) checked every four months, and returned annually for UWF imaging of his optic nerve and a small choroidal nevus. During one visit, while using optomap af, Dr. Stoller noticed that the nevus had started to autofluoresce. Although the choroidal nevus, measuring three disc diameters (DD), had not increased in size, the hyperfluorescence of the lipofuscin gave Dr. Stoller cause to investigate further. A dilated, cross-sectional OCT of the retina revealed that the nevus was significantly elevated, prompting Dr. Stoller to make an immediate specialist referral.

Dr. Stoller also noted that since using optomap technology, there had been a rise in the discovery of previously unobserved retinal pathologies in his practice. As a result, he increased his use of optomap af for all patients presenting with choroidal nevi. Dr. Stoller believes that optomap af facilitates earlier diagnosis, direct treatment and more successful patient outcomes.

A patient named George was referred to Dr. Albert Morier by his primary care physician to be monitored for diabetic progression. George’s ophthalmologist had also made him aware that he had a ‘freckle’ on his retina4. Dr. Morier dilates all patients who have a pre-existing medical condition, utilizing optomap as complementary to the dilation. Unfortunately, George did not dilate well and UWF imaging proved vital in his case. Along with trace diabetic retinopathy, Dr. Morier noted that the ‘freckle’ was actually a large lesion that had extended beyond the choroid into the retina. A referral was expedited for further assessment, and malignancy was confirmed.

In general, Dr. Morier has noticed that the number of asymptomatic patients, who have been imaged on the optomap, are increasingly presenting with ocular pathologies. He emphasized that, “It is knowing that likely I will not have missed something with the ultra-widefield view that optomap provides and that allows me to sleep better. It is really this that matters – quality of care – and peace of mind.”

Denise Kniefel, OD has been using Optos technology since 2004. In 2008 her her optomap image showed the presence of a small nevus. She had been monitoring it herself on a regular basis, and in 2013, she noticed a slight change.

She immediately contacted a specialist who confirmed that the nevus had converted into a melanoma. She sought additional treatment at Massachusetts Eye and Ear and attributes the early detection of the change as key to her ongoing and successful treatment. Dr. Kniefel’s personal experience has compelled her to recommend UWF imaging to all her patients and those within her personal community5.

As highlighted above, and in other similar cases in general, the proactive, routine use of UWF imaging provides a complementary, comprehensive diagnostic modality to support early detection, timely referral and treatment of retinal pathology, particularly in asymptomatic patients. optomap technology supports improved patient outcomes, with greater patient participation, compliance and satisfaction. To find out more about optomap and to find an eyecare professional who uses optomap in their practice, please visit our website.

Sources:

1-2. Mark R. Kapperman, OD. Taking Retinal Imaging to the Next Level. Consider ultra-widefield imaging as a practice enhancer. Advanced Ocular Care. Cover Focus. November/December 2015. http://eyetubeod.com/2015/12/taking-retinal-imaging-to-the-next-level

3. Patient story – Jeffry: http://blog.optos.com/wp-content/uploads/2017/08/Patient-Story-Jeffry-1-1.pdf

4. Patient story – George: http://blog.optos.com/wp-content/uploads/2017/08/Patient-Story-George-1-1.pdf

5. Patient story – Denise: http://blog.optos.com/wp-content/uploads/2017/08/Patient-Story-Denise-Portrait-1-1.pdf