UWF Imaging Assists in Discovery and Follow-Up Care of Blunt Eye Trauma

When 29-year-old Emmy came to see Uwe Canting, OD at Canting Optometry in Cary, NC, she was relatively certain that her eye was fine, but wanted to seek reassurance from her optometrist.  Emmy had received a high-impact, full-blown soccer ball to the eye during a soccer match the preceding day and while having no symptoms other than slight discomfort from the bruising, she realized that the impact was severe enough that something unseen may have occurred.

Canting notes that Emmy presented with a black eye OD, while her visual acuity was 20/20.  “The eye itself looked fine. Other than the ecchymosis, there were no immediate concerns. There was no apparent subconjunctival hemorrhage and no recession of the iris.  But, while dilated, I could see instantly that it was not normal and decided to capture an optomap image.  Sure enough, the image clearly showed the whitish sheen of Commotio retinae superiorly temporal.”  Canting recalls, “The beauty of this situation was that I had her optomap image from her last visit and I could show her, clearly and tangibly, what had occurred in her eye.”

He adds that optomap has proved to be extremely valuable for patient education in a variety of scenarios because his patients love to be able to see what he sees and better understand their ocular health. “There is a wonderful opportunity to educate my patients when I use optomap to help explain the anatomy of their eye. If the patient is anxious, we may review the image right away. Otherwise I save it for the end of the exam. If there is an issue I can easily show them, better than it could be explained. Otherwise, it simply puts their mind at ease.” In Emmy’s case Canting could show her the pathology and stress why she should have further examination. Canting referred her immediately to the retinal specialist who reported later that he would be following Emmy’s condition to ensure that no subsequent issues developed.

 

optomap image of Emmy’s right eye, post trauma showing evidence of Commotio retinae

Commotio retinae is a term that describes the damage that occurs to the outer retinal layers, caused by shock waves that surge through the eye from the impact site of a blunt trauma, such as Emmy’s soccer ball incident.  Often the damage is recognized in the posterior pole but can also manifest, as it did for Emmy, in the periphery where it may be overlooked on a standard central pole retinal view.   While most cases of the condition resolve spontaneously within a month to six weeks, more severe cases can cause temporary or permanent vision loss.  Secondary issues can include choroidal neovascularization, retinal tears, detachment, zonular dehiscence, angle closure glaucoma and lens dislocation.

Rather than shrug off the soccer ball impact injury, Emmy was wise to seek a medical opinion and was fortunate that the injury was not more severe. Canting describes how optomap was a valuable tool in the discovery of the damage and the critical follow-up care that would give Emmy peace of mind.  “She called me later, to tell me how grateful she was that I had seen the issue and had referred her to the specialist for further evaluation.”

As May is Healthy Vision Month, let’s all use  Emmy’s story as a reminder to the importance of the often-overlooked recommendation encouraging protective eyewear for all ages in sports that could involve impact to the eye.

AAO recommends the following Daily Practices for eye health:

  • Regular eye exams to detect subtle changes in the eye
  • Wearing UV protection sunglasses
  • Wearing safety glasses while playing impact sports or doing work about the yard/house that may present hazards to the eye
  • Proper contact lens care
  • Eating a healthy and balanced diet
  • Cessation of smoking

Protect your vision – and visit an eyecare professional who uses optomap ultra-widefield retinal imaging in their practice!

May is UV Awareness Month – Be Wise and Protect Your Eyes!

As summer draws near, most of us long for the glorious warmth of the sun and we dream about, and plan for, the recreation we will enjoy. Unfortunately, while awareness of the importance of sunscreen and UV protective clothing has increased, the impacts of all that fun-in-the-sun on the eyes is still often overlooked.  Most people do not realize that 20% of all cataracts are the result of UV ray exposure, and that number has been dramatically increasing in recent years.

But what is this invisible threat exactly?  And how does it impact us? Ultraviolet radiation is measured in nanometers (nm). It is categorized in three basic terms and classified by the strength of the UV ray:

  • UVC: These rays are below 280 nm. The upper atmosphere absorbs these so they do not reach us, therefore protection from these rays is not overly necessary.
  • UVB: These are between 315 – 380 nm. These manage to make it to the earth’s surface and are notorious for damaging sight. They can cause snow blindness, but are notably responsible for sunburn and several types of skin cancer. Research has shown that these rays are strongest during the summer and at higher altitudes.
  • UVA: These are the most dangerous being 315 – 380 nm. They are known for causing chronic eye damage. Studies have indicated that these rays get absorbed by the lenses of our eyes leading to damage of the retina. They contribute to the occurrence of cataracts, are also a major cause of aging and unfortunately can pass through clouds, glass, water and clothing.

source: http://mommymandy.com/uv-safety-for-young-eyes/

But what about Vitamin D?  A little sun exposure is healthy for us, right?  Vitamin D is essential to help your body absorb calcium and promote bone growth. Vitamin D is also beneficial for other important body functions and it has been shown to be essential to a healthy immune system.  However, just 5-15 minutes in the sun is enough to help stimulate the production of Vitamin D.

Prolonged UV exposure has numerous immediate and deleterious negative impacts. Many skin cancers can occur on the eyelids and external features of the eye.  Additionally, while ocular melanoma is rare it is the most common eye cancer in adults. Because of the increasing number of UV related cataracts and eye cancers; Prevent Blindness, and many other organizations, strongly recommend that everyone utilize UV Protection eyewear, not only those who engage in outdoor disciplines and recreation. It is recommended that sunglasses and UV treated daily wear should be 100% UV absorbing for UVA and UVB light.

When we are caught up in the delightful pursuits of summer – particularly exuberant children – we tend to overlook the simple proactive measures that we can take to protect against vision loss and UV related eye damage and even life threatening ocular cancers.  In addition to taking a few extra moments to protect yourself and your loved ones before rushing out into the sunshine, it is imperative that people take the time for annual eye exams. An optomap screening is an excellent, expedient way to get a comprehensive view of the retina and to gain essential information about ones ocular health. optomap is the only proven, clinically-validated, ultra-widefield retinal image that can capture 82% or 200⁰ of the retina, which can reveal incredibly subtle changes from the central pole to the far periphery of the retina in a single capture – and in a fraction of a second – so you can get out there (well-protected, of course) and enjoy that summer sun.

Visit our website to learn how optomap can assist your local eyecare professional in protecting your sight and general health.

Women (and Especially those Over 40) – It is Time to Pay Attention to Your Eye Health!

April is Women’s Eye Health and Safety Month, which may, at first glance, seem a bit of a niche concern. However, according to the organization Prevent Blindness, women make up the majority of the 4.4 million Americans, age 40 and older, who are visually impaired or blind.  More women than men have age-related macular degeneration, cataracts, and glaucoma.  These numbers will only continue to increase in the years to come.

Although there are no cures for some of these diseases, many of the effects may be lessened through early detection and treatment.  A 2015 survey found that one in four women had not received an eye exam in the past two years. Since women may not be aware that they are at greater risk than men of developing eye disease that could lead to serious vision impairment, practitioners can take the opportunity during Women’s Eye Health and Safety Month to stress the importance of paying attention to eye health and the importance of an annual eye exam.

A comprehensive eye exam should include a thorough examination of the retina, including an optomap, which is complementary to a DFE and an excellent tool for screening and for patient education. Because an optomap image can be obtained in less than ½ second, it leaves ample time for the practitioner to educate on eye health.

Click on image to read full story

Dr. Germain Burke and Britta

Dr. Germain Burke, of Burke Optometry in Lodi, California, understands the value of optomap in communicating with and educating her patients. She recounts a story about her patient, Britta, that demonstrates how an optomap screening can reveal issues in asymptomatic patients, as well as, patients who have trouble communicating or who may minimize health issues or concerns.

In July 2017, Britta made an appointment with Dr. Burke for a routine eye exam.  She did not share that she had been concerned about some vision distortion in her left eye.  However, Burke approached the exam as she would any routine visit, and fortunately for Britta, that included an optomap. The ultra-widefield digital retinal image provides a 200° view of the retina, out to the far periphery, and this .04 second capture revealed a large shadow OS.  Burke realized immediately that she was looking at a well-progressed melanoma.

“The melanoma was in the periphery but very clear.  It was a Friday afternoon so she took a picture of the optomap image on the screen and sent that immediately to her primary care physician through a secure portal.  Her PCP responded quickly and got her set up for a retinal exam on Monday.  On Tuesday she was in to see the oncologist and a PET scan, thankfully, showed that the cancer had not spread.”  A week later Britta had a radioactive plaque sewn into the sclera opposite the lesion and is now being monitored for efficacy and progression.

“I believe I am a good doctor but with optomap I feel like I am going to be able to catch big or small issues that I might not have seen otherwise.  I can provide more accurate notes and detailed information when I refer a patient on to a specialist. It facilitates the communication for follow-up care as well, and monitoring is more accurate,” says Burke.

She notes that they brought optomap technology into the practice shortly before she saw Britta, and stresses that this case is one of the reasons that she and the staff at Burke Optometry are glad that they did not wait to make that purchase. “Because we had that optomap image, the communication and the responsive action worked as smoothly and quickly as it possibly could have.  I really believe there was no other way it could have gone as well.  This is one of the reasons I sincerely feel everyone should have an optomap taken as part of a comprehensive exam.”

Visit our website to find a doctor such as Dr. Burke, who has optomap in their practice.

 

Doctor Discovers His Own Pathology with Proven UWF Technology

When Vince Young, OD introduced the Daytona from Optos in his practice, he volunteered to be the imaging guinea pig while his staff was being trained on the device.  He was unnerved when he reviewed his images with the trainer and somewhat uncertain about what he was actually seeing.  He knew what a posterior subcapsular cataract (PSC) looked like through the slit lamp but was surprised by what the optomap image laid evident.  While optomap is known for being able to penetrate through medial opacities far better than white light modalities, a PSC, which tends to be denser than other types of cataract, will cast a shadow on the retina revealing the issue. A concerned Dr. Young sent the image to his wife, Lindsey Brewer Young, OD.  When she reviewed the image on her phone she immediately responded, questioning whose eye she was regarding.  Learning it was her husband’s image she returned to the clinic, conducted a dilated exam, and confirmed that it was indeed a PSC that had been revealed in the optomap image.

Doctor discovers his own pathology with optomap

Read the entire story by clicking on the image

Young, who is 40, had no reason to suspect he would have cataracts which are more typically associated with the elderly population.  A subcapsular cataract occurs at the back of the lens and can be caused by a variety of circumstances such as systemic issues and some forms of medication. Posterior subscapsular cataracts are also more difficult to remove, due to adhesion of the cataract to the lens capsule, and there is an increased risk of capsule rupture during removal.1   However, Young’s cataract surgery on both eyes was successful and his vision is fine.

This discovery has become an excellent tool in communicating the importance of optomap to his patients.  The image hangs in the exam room while Young and his staff frequently share the story. “If the doctor didn’t know he had a cataract, how would anyone else know?” they say, underscoring how valuable the screening can be.  This unusual story has assisted with the elevated level of acceptance the optomap receives in the office.

Blanchard Eye Care sits in a quiet community outside Blanchard, OK and Young was concerned that he would have difficulty getting people in the rural community to embrace the technology.  He, however, was convinced that if he at least broke even it would be worth the investment based on the clinical value.  “Before purchasing the Daytona, I asked several of my colleagues about their experiences and they referred to it as a ‘no—brainer’,” says Young. He stresses that while the technology has without a doubt brought a financial bonus, the value of what it provides clinically far outweighs the monetary gain.

Young stresses how the exam experience has changed with optomap in an extremely valuable way when it comes to patient education.  The optomap image enables him to help his patients understand exactly what is occurring in their eye, or even just to provide reassurance that all is well.  “Even if there is no pathology, patients want me to take the images every year. They want to see what I see.”

Young happens to be color blind and further identifies another contribution that optomap brings to him, personally.  Because of this, a slit lamp view can sometimes make it difficult for him to distinguish between a hematoma and a nevus.  “However, the optomap image allows me to look at the different channels, and these features really jump out on some of the layers.  I’m much more positive about my diagnoses now.”

Dr. Young’s story demonstrates that it is not only possible for practitioners to image themselves and discover retinal pathology but also discover if significant opacities reside in the media as well.

Today, cataracts affect more than 22 million Americans age 40 and older. And as the US population ages, more than 30 million Americans are expected to have cataracts by the year 2020.2  optomap technology is being increasingly utilized in cataract surgery clinics for immediate views of the retina.  The ultra-widefield view is obtained through problematic, medial opacities, where white light has difficulty, revealing any retinal issues that might be a concern prior to surgery, as well as, following surgery. The ability to quickly and easily observe and document retinal health before and after cataract surgery provides both the patient and practitioner a tremendous peace of mind.

optomap, helping doctors identify pathology, even on themselves. Let us know if you are ready to bring optomap to your practice or clinic.

1http://optometrytimes.modernmedicine.com/optometrytimes/content/tags/cataract/types-cataracts-and-their-underlying-conditions?page=full

2 http://www.allaboutvision.com/conditions/cataracts.htm

 

optomap® Helps Guide Laser Treatment for Retinal Toxicity Issue

A young woman with a history of depression, drug & alcohol abuse was seen in a Houston clinic after injecting isopropyl alcohol into her left eye. According to the patient, her eye was bothering her and she believed the rubbing alcohol would help. She went to the clinic due to a loss of vision in the eye she injected.

Source: Optos

Source: Optos

Examination

Visual acuity in 20/20 right eye and hand movement at 2 feet in the left eye. Intraocular pressure was 13/12 by applanation. A dilated retinal exam was performed with findings of retinal infarct, vascular pruning and a few intra-retinal hemorrhages, macular edema, rare vitreous cell and possible operculated hole at 3:00. An optomap was taken and confirmed an operculated hole and air bubble with a small hemorrhage superiorly, near the hole where patient performed the self-injection. The imaged confirmed the diagnosis of retinal toxicity, vascular ischemia, hemi-retinal artery occlusion, macular edema and a retinal hole.

Discussion

The risks, benefits and alternatives of treatment discussed with patient and father. The father consented to laser treatment and a grid laser was performed. The patient was admitted to hospital for a psychiatric evaluation following the laser treatment. Four days post laser treatment, the exam showed no visual acuity changes, the vitreous had cells and an optomap was performed, which documented that the air bubble was gone, grid laser treatment stable and a small hemorrhage at edge of laser treatment, which will reabsorb with time.

Conclusion

 

The ultra-widefield optomap documented the far peripheral hole with this challenging patient and also helped guide the laser treatment. A conventional camera image would not have been able to capture the hole. It is likely that eye steering with a camera would not have been possible due to the condition and cooperation of the patient.

optomap can also help you with guiding treatment options for better patient outcomes.

 

Contact us to learn more about partnering with Optos to benefit your patients and your practice.