Article Date: 11/1/2010

See the Big Picture — and the Small One
Tech Connection

See the Big Picture — and the Small One

Complement wide-view Optomap screening with the fundus camera's up-close detail.

By Michael Rothschild, OD, Carrollton, Ga.

When I enter an address into my car's navigation system, it shows me a map of the whole trip. As I drive closer, that view zooms in to the street level and the very building I'm seeking. I think of my Optomap (Optos) and fundus camera the same way. The Optomap is my wide-angle view, the screening tool I use to capture an image of the macula and the retinal periphery in a split second, while the fundus camera lets me zoom in, target details and document progression.

In my practice, these complementary technologies deliver the best of both worlds in an efficient package. Depending on the type of practice that you have, the combination may offer you the same efficiencies and clinical advantages.

The Advantages

The things I do with these instruments can be done without them as well. You can draw and describe without a fundus camera. You can take fundus images and not Optomap images. But the fundus camera increases efficiency, and Optomap lets us capture the big picture very easily and comfortably for patients, without the positioning and flashes of the fundus camera.

Clinically, Optomap is a great tool because you can see any complications with the nerve. The number one application is in glaucoma because it shows you any nerve fiber layer loss, but it also reveals other problems such as atrophy, drusen, swelling of the optic nerve, tumors, tears, rips and scars.

I've also been surprised how many tiny hemorrhages in the periphery the images have revealed in patients with diabetes, even those who have been fine for years. Once I find these or other defects, I zoom in to see more detail and document them with the fundus camera. Now we've had both instruments for several years, so at each exam, we can check the images against those from previous visits to check if they're new or if we missed them previously, as well as if there is any change in size or location.

Which Tools Do You Need?

My practice has two sides to it — one geared to getting patients into the best eyeglasses possible and another focused on following ocular disease and tracking suspicious situations. Both the Optomap and the fundus camera pay for themselves in this busy practice, but if your practice doesn't see a lot of refraction and disease, then you might choose just one of the technologies instead of both.

As a new OD, you must have a clear vision of your new practice and long-term goals, with optimal patient care as a cornerstone. If you have a busy primary care practice, then the Optomap will help you with a wide variety of problems. But if you do a great deal of medical care, the fundus camera may be the best tool to help you detect nuances of trouble related to disease and its progression. If, like me, you treat both, then I recommend using both of these complementary devices. nOD

Dr. Rothschild is chief executive officer of West Georgia Eye Care in Carrollton and founder of

Optometric Management, Issue: November 2010