By Mary Deligianni
Optometrist
Rozelle, NSW

For many years I have had an equipment wishlist.  Like many Optoms I’d imagine, the first thing on my list was a retinal camera.  Five months ago, my wish was granted and I haven’t looked back since.  This one piece of equipment has exposed my strengths and helped me address my weaknesses.  It has become an essential tool in practice building and quality patient care.  I am now convinced that no practice should be without one. 

On arrival of the camera, I had what could only be described as performance anxiety.  I had previously used a camera at another practice for a limited period and just minimal exposure to the old polaroid cameras at Uni all those years ago.  I found the support I received from Optical Manufacturers’ personnel was invaluable.  Written material provided with the Topcon camera was easy to follow and a helpful resource.  In addition, tip from colleagues who had years of experience with Topcon cameras set me on my way.  It wasn’t long before I was trigger happy and feeling confident.

I consider retinal imaging to be the premium in patient care and I don’t hesitate in telling them so.  It allows us to document findings that can then be compared further down the track whether it be two, five, ten years or beyond.  We will have a generation of patients for whom we will be able to pull out a photograph in decade’s time and allow direct, accurate comparison.  This could, in effect cut down the need for unnecessary, expensive testing and make findings more meaningful.  I offer retinal imaging to all patients over 15 and have had very refusals.  Retinal imaging is also done if clinically necessary for patients under 15.  I recently photographed an 11-year-old boy with CD ratios 0.75+OU.  This patient will now have a permanent record of his disc appearance and no matter where he may be in his adulthood, an optometrist will be able to compare disc appearances and make a far more accurate assessment.

After taking the images, I sit the patient directly in front of the computer and go through the findings in detail.  Patient love the detail and are fascinated by the technology, no matter what age.  I have had countless referrals from patients so impressed by the care that they go home or to work and rave to anyone about it, family friends, neighbours and work colleagues.  By being able to visualise the findings, patients are more likely to be compliant in terms of follow up appointments as they have a direct understanding of what is it we are looking for or what we are monitoring.  Patients with a family history of glaucoma, ARM or any other retinal or systemic condition very much appreciate the advantages of having documented images over time effectively allowing for more careful monitoring of their own ocular health.

Another surprising benefit is the ability to send images to colleagues, whether optometrist or ophthalmologist, if there are any doubts or questions regarding an image.   It allows for interesting case discussion and confirmation of findings.  This can also allow an ophthalmologist to determine how urgent a referral needs to be which is especially important during busy periods e.g. holiday periods.

The thing about this technology is that you get spoilt.  Whenever I use a direct ophthalmoscope, I am immediately aware of its limitations.  I feel as though I am looking in with blinkers on and am consciously aware that there are areas I cannot see.  I keep thinking back to the first patient I photographed who had a choroidal naevus in the periphery the size of the optic disc.  I would have never spotted it with a direct ophthalmoscope undilated. 

The only thorn in my side when doing retinal imaging has been consulting room lighting.  We recently outfitted our practice to be natural light filled and the difficulty in darkening my room has impacted upon the ability to photograph all patients undilated.  Most patients can be photographed without the need for mydriasis however there is a percentage of patients who require dilation in my practice.

I look forward to the next item on my wishlist but I doubt it will have the same impact as my Topcon retinal camera.  For anyone who has one on their wishlist, I cannot stress this enough…….do not wait any longer.  You don’t know what you are missing.