Advances in technology are expanding opportunities in optometry for earlier detection and treatment of a multitude of sight- and life-threatening pathologies.
Standard examination procedures typically proceed from anterior to posterior segment, via slitlamp, tonometry, binocular indirect ophthalmoscopy (BIO), OCT and retinal camera. Considering that numerous studies show that pathologies are often initially evident in the periphery long before problems manifest in the central pole, a thorough examination of the retina is essential for a comprehensive examination.
Following pretest and examination of the anterior chamber, standard BIO will often direct the rest of the examination, and when a fundus issue is detected, time-consuming stratagems are often necessary to obtain a better view and a retinal image for documentation.
The introduction of ultra-widefield (UWF) imaging into our practice has altered examination protocol, essentially reversing the order of how we utilise our technology and examine patients.
The Daytona Plus UWF allows a 200-degree, high definition, digital view of the retina in a single non-contact image in less than 0.4 seconds. This image is called optomap. Daytona Plus image modalities include a colour composite view, red channel (choroidal) view, green channel (sensory retina) view and autofluorescence. The evolution of optomap image resolution has improved to a degree that it is comparable to our retinal camera; however, our ability to access and assess 82 per cent of the retina via optomap has resulted in a notable increase in pathology discoveries.
During the first two months with the Daytona Plus use we have discovered in asymptomatic patients numerous retinal tears, peripheral lattice degeneration and small holes in the far periphery that have self-sealed. Some of these were patients we had seen previously and when we compare the optomap images to previous retinal photos, these pathologies are not evident.
Over this short time, the conclusion that we may be missing emergent pathology has influenced how we proceed with examinations. The optomap ease of use and rapid image acquisition have similarly contributed to this adaptation. The Daytona Plus allows us to quickly obtain expansive images in populations that are difficult to dilate, refuse dilation or present with multiple issues that complicate a prolonged, comprehensive examination.
Que is a 64-year-old patient who presented six weeks ago with complaints of a shadow slightly obscuring his vision OD. He did not speak or understand English and was accompanied by his son who spoke only slightly more English, but attempted to translate directions.
Achieving desired results during his dilated retinal examination with BIO was difficult. When a direction was given, Que would retract from the light from the headset and look to his son for translation. This behaviour resulted in a protracted examination with insufficient information. I was able to clearly see a floater that did not have the appearance of retinal tissue. I also caught a glimpse of a possible issue superior temporal OD but I could not obtain a suitable view of the periphery. Although I did not anticipate any better result we brought him to the Daytona Plus for imaging.
However, the target in the device made little explanation necessary. I was able to quickly obtain a good 200-degree view of the retina of both eyes without trouble. On review of the images, three large horseshoe tears were clearly evident in the far periphery OD (Figure 1). Que was immediately referred to a retinal specialist and the tears were successfully sealed the following day.
Figure 1. Optomap of right eye; even with blink disruption, the horseshoe tears on the periphery are clearly visible
Figure 2. Optomap of left eye
Use of the Daytona Plus has resulted in greater efficiency that allows us to see more patients and ultimately translates into enhanced quality of care. Utilising the technology for screening accommodates a more comprehensive examination with an unparalleled scope for greater discovery and documentation. The optomap experience has been well received by patients and is less intrusive than other methods. The images provided by Daytona Plus have expedited and simplified the examination of my patients while providing powerful diagnostic and educational elements for our staff and patients.