Optometric Management Tip # 204 - Wednesday, December 14, 2005
The Retinal Camera as a Pretest
Continuing with the topic of retinal photography as part of a routine eye exam, I would like
to offer a few more tips that I have found useful. Digital retinal cameras and the software
that allows you to view the images have made amazing advancements, yet nearly half of practicing
optometrists donít use this technology, according to the AOA. Of the doctors who do have access
to a retinal camera, I suspect many use it on only a small percentage of patients.
If youíre ready to move to the routine use of retinal imaging, here are some nuances you may not
be aware of.
Conversion to digital
- If you currently have a non-mydriatic retinal camera with a Polaroid or 35mm attachment, you
may be able to convert it to digital at surprisingly low cost. Instrument companies can often
provide an adaptor, a new digital camera and the computer software to fit an existing camera.
- When I converted my Polaroid retinal camera years ago, the savings I realized by no longer
buying Polaroid film more than paid for the digital upgrade.
- You get a great bonus when you switch from a regular camera to digital: the brightness of the
flash is reduced by about half the intensity. This gives you two important practical advantages:
1) Patients wonít mind having the procedure done. They no longer have to experience that extremely
bright and uncomfortable flash that almost knocks you off your chair. 2) The technician can
immediately take the picture of the fellow eye. Formerly, with the bright flash, the consensual
pupil response would be so strong that the second eye always came out poorly, or you had to take
it later. With digital, they both look great right away.
How to use it
- The computer software allows the digital camera to snap the photo, store the image in a
database with date and patient identification, retrieve the photos and analyze them.
- You definitely want to have the retinal camera system networked into all the exam rooms,
so the photos can be viewed there with the patient. Any other way is not efficient and loses
the wow factor.
- Photos can be printed in very high quality on photo paper with an ink jet or laser printer,
but you will find you rarely do it. One of the big advantages of digital cameras is that the
images are stored electronically.
- Digital photos can be emailed to another doctor for consultation purposes. They are often
stored as a JPEG file and attached in the usual way.
- Of course, you need a large capacity hard drive to store the images, and it must be backed
up on a regular basis. This is just standard protocol for todayís technology.
- We simply use the retinal camera as a pretest instrument, performed by an optometric
technician as part of the work-up.
- We placed the retinal camera in a small room by itself, so it is always available without
causing a bottleneck. The procedure only takes about three minutes. It is advisable to have a
door on the camera room so you can make the room quite dark if needed to increase pupil size.
- Some patients with very small pupils or media problems will require dilation to obtain a good
photo. Thatís no problem; we just shoot the photos again on the way back into the exam room after
dilation. No wasted film when itís digital, just delete the bad shots.
- The technician brings up the right and left retinal photos on the exam room monitor as she
completes the pretesting work. If there are previous photos on file, the tech brings up the
previous pair as well for comparison.
- When I enter the exam room (after I say hello, wash my hands, chat a little bit and review
the case history), I discuss the pre-tests and look at the retinal photos with the patient. I
use the mouse cursor to point out the various landmarks of the retina. I often click on an area,
like the optic disc, and zoom in for a close look. If there is an obvious retinal problem, I may
delay discussing it until I complete my exam and have more information. Examining the retinal
image in advance makes my physical exam easier and faster. This all goes very well with just a
little experience. Patients love the technology and the immediate feedback about their eye
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management