optomap Enables Detection, Diagnosis, and Guides Treatment in Age-Related Ocular Pathology

September is Healthy Aging month, however despite age related changes to vision, ocular health is often overlooked.  As the aging population grows, adding the first influx of generation X to the baby boomers in the over 50 demographics, the incidences of glaucoma and Age-related Macular Degeneration (AMD) are also on the rise.

Recent studies have demonstrated how optomap ultra-widefield™ (UWF) retinal imaging is fulfilling a need in supporting the detection and management of both ocular and systemic diseases associated with aging. UWF imaging provides a high resolution, single-capture image of 82% (or 200 degrees) of the retina.  Studies have confirmed that the resolution of the optomap image – is comparable to fundus photography – which captures 11% of the retina, in detection of diseases such as diabetic retinopathy, AMD and uveitis.  Additionally, studies have found that the additional area captured by optomap can enhance the ability to detect, diagnose and manage diseases in comparison to fundus photography and be captured more efficiently.  UWF is being increasingly used in optometric and ophthalmic settings and enables eye care professionals to detect, diagnose, document and treat ocular pathology including retinal disease that may first present in the periphery.

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in adults over age 50. The Centers for Disease Control and Prevention estimate that by the year 2020, 196 million people worldwide will be living with some form of AMD.

Although there have been many discoveries in the understanding of the causes of AMD, including links to genetics, there remains much unknown about this complicated, degenerative disease. Over time the retinal periphery has been able to be more easily studied in early AMD to determine the value in the detection and/or monitoring of the disease.  However, with the advent of multi-modality UWF imaging, novel studies are beginning to demonstrate this value. Color optomap imaging captures the structure and fundus autofluorescence (FAF) the function of the Retinal Pigment Epithelium (RPE) which is where AMD manifests within the eye. Studies have revealed that 97% of patients with AMD have evidence of the disease in the far periphery.

This outcome demonstrated that drusen were seen in a majority of eyes, strongly indicating that AMD is more than a macular condition but one that involves the entire retina. This is being investigated in a further study that will determine whether these peripheral changes are associated with the progression of the disease.   Read the Full Article

Glaucoma is another primary cause of blindness worldwide, affecting an estimated 70 million people. While early detection is key to taking steps to prevent vision loss, glaucomatous vision impairment is irreversible.  Unfortunately, glaucoma can be asymptomatic until the late stages, at which time the prognosis is poor.

The gold standard for detection and diagnosis of glaucoma is a clinical examination with dilated slit lamp biomicroscopy conducted by a glaucoma specialist.  However, this level of expertise is not always feasible or readily available to broadly evaluate an aging population. Exam efficiency has been increasingly addressed via use of color digital stereoscopic photography and/or retinal tomography via SD-OCT.

A recent  study explored the potential suitability of ultra-widefield retinal imaging in diagnosing glaucoma in situations where slit-lamp biomicroscopy or digital color stereoscopy are not available. The purpose of the study was to evaluate the reproducibility and validity of UWF in estimating Vertical Cup to Disc Ratio (VCDR) measurements and was the first study of its kind to explore whether optomap imaging could be suitable as a diagnostic support tool for glaucoma.

The study evaluated the data from color digital stereoscopic fundus images (CDS) and UWF images.  All the photographs and images were graded by two masked trained graders and one masked glaucoma specialist. The optomap images were graded using the ‘measure distance’ tool on the OptosAdvancesoftware, to measure and record cup to disc ratio (CDR).

The study demonstrated an almost perfect agreement between CDS and optomap when assessed by the glaucoma specialist.   The study concludes that optomap imaging has a high reproducibility in evaluating VCDR and agreement with stereoscopic optic disc imaging and indicates that UWF imaging may be suitable for glaucoma evaluation in settings where CDS is not available. Read the Full Article here….
Or visit our website to learn more about clinical studies utilizing optomap technology

https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/macular-degeneration
http://www.allaboutvision.com/conditions/amd.htm
https://nei.nih.gov/health/maculardegen/armd_facts
https://www.aaojournal.org/article/S0161-6420(16)31491-9/abstract
http://www.aaojournal.org/article/S0161-6420(16)31491-9/fulltext

optomap Image is a Savior to Teen’s Vision

With August deemed Children’s Eye Health and Safety Month, there cannot be enough stress placed on the importance of protecting children (including teenagers) eye health.  Healthy eyes and good vision are essential for the physical and educational development of children. Most children have healthy eyes. However, vision problems can begin at an early age and go unnoticed by both children and their parents. Early detection and treatment are indispensable in preventing conditions that could potentially cause problems or permanent vision loss.

Christina, a high school student in Manhattan Beach, California walked into her eye doctor’s office thinking it was just going to be another eye appointment and yet another glasses fitting.  Dr. Dale Choi, of Manhattan Beach Vision Group, recommended Christina get an optomap image as part of her exam that day.  To their surprise, the image revealed a significant finding.  Dr. Choi discovered a retinal hole with a large sub-clinical detachment in her left eye.  Dr. Choi reviewed the image with Christina, explaining that she would need to be referred a retina specialist that same day, to repair the hole and save her sight. Fortunately for Christina, the local specialist was able to repair the hole with no damage to her vision.

Retinal Detachment – Image courtesy J Edward Ysasaga, MD

According to Dr. Choi, optomap has diagnosed many systemic conditions that otherwise would have gone unknown and often gotten worse.  Without it the optomap, Christina is unsure how she would have known about the detached retina before it was too late.  “It gives them peace of mind. It gives them ultimately the care that should be standard in all eye exams,“ says Dr. Choi.

Optos is committed to educating parents on the importance of having their children’s eyes checked regularly. Protect your children’s eye health by making an optomap part of their yearly comprehensive eye exam.  Visit our website for more sight-saving stories like Christina’s and find an optomap provider near you to schedule your child’s eye exam today!

https://www.preventblindness.org

Back to School Means More Than Backpacks and Lunch Boxes – Don’t Forget the Eye Exam!

While to some it may feel as though summer has just begun, others are already feeling the pressures of checking off every item on their back to school lists.  With all the hassle of stocking up on school supplies or finding the perfect pair of shoes, there is often one important item that gets left off every parent’s list – a comprehensive eye exam.  Although schools generally do some basic testing of children’s vision, there is no doctor to perform a comprehensive exam or diagnose problems with your child’s eyesight.  According to experts, nearly 90 percent of what is taught in school is done so visually, therefore without excellent vision, children are left at a disadvantage.  Those with poor eyesight may struggle with school and learning, leaving them unable to reach their maximum potential.  A yearly comprehensive eye exam can not only ensure your child’s vision is healthy or corrected, but also rule out diseases that can potentially lead to vision loss.

Just as their bodies are rapidly growing, children’s eye are also changing. The slightest change in vision can cause eye strain, headaches or blurred vision which can be very distracting in school.  Myopia and hyperopia, also known as near or farsightedness, are both common conditions in young children, with the ability to worsen rapidly during the growing years until later stabilizing in teenage years and into their early twenties.

Additionally, with recent increases in digital technology, both at home and in schools, it is important to monitor the face time children and teens have with their digital devices such as laptops, tablets and cell phones.  Many individuals suffer from physical eye discomfort after screen use for more than two hours, reflecting collective symptoms know as digital eye strain.  According to The Vision Council, 72 percent of Americans report their children and teens get more than two hours of screen time per day while 30 percent of this group report they experience at least one of the following symptoms after being exposed for more than two hours:

  • Headaches
  • Neck/shoulder pain
  • Eye strain, dry or irritated eyes
  • Reduced attention span
  • Poor behavior
  • Irritability

With a growing number of schools implementing iPads, tablets or laptops in the classroom, it is even more important to ensure your children’s eye health with routine comprehensive eye exams and identifying any symptoms of digital eye strain in addition to any headaches, eye strain or blurred vision.

Adding comprehensive eye exams to your yearly back to school routines will help ensure a successful school year as well as protect your children’s eye health and future.  Speak to your doctor about including optomap® as part of the exam – it is a non-invasive option for your child and takes only seconds to get a highly-detailed view of the retina, which is critical for early disease detection.

http://yoursightmatters.com/make-eye-exams-back-school-tradition/
https://www.allaboutvision.com/parents/learning.htm
https://www.thevisioncouncil.org/content/digital-eye-strain/teens

 

The Retina – A Window to Alzheimer’s Disease

In a novel study from Queen’s University Belfast, researchers demonstrate that the eye could be a window to the brain. The results of the study, recently published in the Journal of Ophthalmic Research, show how degenerative brain diseases such as Alzheimer’s Disease (AD) can be monitored via ultra-widefield (UWF) retinal imaging.  The retina is a part of the central nervous system and shares structural and functional features with the brain. Altogether 59 AD patients and 48 controls were entered into the study.  They were imaged utilizing ultra-widefield imaging from Optos.  This advanced technology, using red and green lasers, captures a 200 degree, high-resolution digital image of the retina in less than ½  second, reaching regions of the retina that have been previously inaccessible with other methods of imaging.

Measuring biomarkers, such as drusen and vasculature width gradients in delineated quadrants of the retina, the researchers found that these changes, particularly in the peripheral retina, could be associated with degenerative brain conditions such as AD. Specifically, the markers that were chiefly considered were drusen and vasculature changes. Drusen are deposits of fats, minerals, and proteins and are normal symptoms of aging that appear as yellowish spots in the layer beneath the retina.  While they are harmless and typically begin to appear after the age of 40, an increased occurrence in number and size can contribute to the degeneration of the retina.  In the study, at baseline and follow up, the optomap images revealed that drusen accumulation, particularly in the superior nasal quadrant, were increased and significantly associated with positive AD status as compared to the number of drusen that would be normally expected in the control group. An additional novel element of the study was that by utilizing the UWF view of optomap, the width gradient of the vasculature could be observed in entirety from the macula to the far retinal periphery.  The study found that people with AD have blood vessels that are wider closer to the macula and thin as they progress further into the periphery.  This can impede the flow of blood and the essential delivery of nutrients and oxygen in the periphery, leading to further damage.

The team, led by Dr. Imre Lengyel of Queen’s University, hypothesized that changes in the peripheral retina could be important to explore the association between the eye and the brain. They concluded that their research supported their original hypothesis and that UWF retinal imaging has significant potential for monitoring AD and other degenerative brain diseases via the eye.  Utilizing optomap to evaluate progression of AD may bring important value to this effort because changes in the eye are easier to measure in relation to other methods necessary to evaluate the health of the brain.  Establishing an evidential correlation between the eye and the brain would suggest that utilizing UWF imaging could provide an easier, more expedient access to that information.  Furthermore, UWF imaging provides a much less expensive option to other methods of evaluation, such as brain scans. The researchers demonstrated that by utilizing optomap, they were able to identify early markers that could manifest many years before dementia develops as well as high risk groups who would benefit from preventative guidance. The study notes that to be a reasonable marker of early disease, pre-symptomatic, or early symptomatic patients would need to be followed up over several years to determine the predictive value of the peripheral findings.  Routine optomap exams could prove to be an earlier, easier and more cost-effective method for monitoring the progression of AD, and identifying individuals at high-risk of developing AD.

Grading of vascular parameters on UWF imaging.

Read the Full Article here….
Or visit our website to learn more about clinical studies utilizing optomap technology.

 

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!