Part 2 fundus imaging – presentation for www.eyenirvaan.com

“ FUNDUS IMAGING ”
NEED OF THE TIMES
PART - 2
Rajesh Wadhwa M. Optom, FIACLE, PGDHRM
To view more presentations and articles, visit www.eyenirvaan.com

Fundus imaging –a need
of the times for Indian
Optometry clinics
Part 2

In Diabetic Retinopathy (DR)
• Damaged blood vessels leak in the retina
• Later the blood vessels get blocked
• Leads to formation of abnormal new blood
vessels

vessels
• These new vessels are fragile and can easily
bleed into vitreous

vessels
• These new vessels are fragile and can easily bleed
into vitreous
• These can also pull the retina & cause retinal
detachment
• If the damage to vessels is in central retina, it
causes diabetic-maculopathy & swelling of retina

DR-Haemorrhage & microaneurysms

DR-Venous beading
(irregular calibre of veins)

DR- Intraretinal microvascular
anomalies (IRMA)

DR- New vessels: key characteristic of
proliferative DR

DR- Pre-retinal haemorrhage:
a sign of proliferative DR

Most of DR findings in one image

DR- Cotton wool spots

DR- Cotton wool spotsDid you notice
these names
for credits

DR- Cotton wool spotsDid you notice
these names
for creditsThis can be
your name if
you
photograph
the image

Conventional Color Scheme for
Retinal Mapping
YOU MAY SKIP
READING THIS↓
-Red:
Light red: attached retina
Dark red: retinal arteries, preretinal
or intraretinal hemorrhages
-Light blue: Retinal Detachment
-Dark blue: Retinal veins, margins of
retinal breaks, lattice is outlined in
blue with inside crosslined
--Black: chorioretinal pigmentation
-Yellow: intraretinal or subretinal
exudates
-Brown: nevi, melanomas, choroidal
detachment
-Green: vitreous or lens opacities
Opacities in media, vitreous
hemorrhage

Conventional Color Scheme for
Retinal Mapping
-Red:
Light red: attached retina
Dark red: retinal arteries,
preretinal or intraretinal
hemorrhages
-Light blue: Retinal Detachment
-Dark blue: Retinal veins, margins of
retinal breaks, lattice is outlined
in blue with inside crosslined
--Black: chorioretinal pigmentation
-Yellow: intraretinal or subretinal
exudates
-Brown: nevi, melanomas, choroidal
detachment
-Green: vitreous or lens opacities
Opacities in media, vitreous
hemorrhage

Feasibility of fundus imaging in Indian
optometry clinic
• No dilatation required

optometry clinic
• No structural changes required in
clinic
• Can fit into drawers
• 10 minutes to image & to give print out

optometry clinic
• No structural changes required in
clinic
• Can fit into drawers
• 10 minutes to image & to give print out
• Good for diabetic retinopathy, glaucoma etc.
• Author used Optomed non-mydriatic camera

Taking images through non-mydriatic
fundus camera
• More sensitive
• Images can be zoomed
• Images can be further processed through
software

fundus camera
• More sensitive
software
• Measurements can be more accurate

fundus camera
• More sensitive
software
• Measurements can be more accurate
• If there is an image of previous encounter, more
reliable decisions can be made in follow-up visits
• Some examples follow……

I almost missed these lesions with
direct ophthalmoscopy

• Px h/o DM-6m
(known)
• The lesions
shown here were
initially missed
with direct
ophthalmoscopy

• Px h/o DM-6m
(known)
• The lesions shown
here were initially
missed with direct
ophthalmoscopy
• These were picked
up in fundus
photography
through Optomed
camera & then
reconfirmed with
direct
ophthalmoscopy

Auto correction with regular windows
software
Raw image

Auto correction with regular windows
software
Raw image After auto correction

Image modification
Original image

Image modification
Original image Modified with graduated tint

Why did I not have a fundus camera so far
• Which one to buy
• What is the budget required

• How soon will the instrument pay
back
(expected in 1 yr with 3 Px per day)

• How soon will the instrument pay back
(expected in 1 yr with 3 Px per day)
• Who will teach the skills of using it
• How can I do that as a “drug-less” procedure
• What will I gain after getting the camera
• Most of these are answered in this presentation

Biggest gain
• Society benefits

Biggest gain
• We will have patients
who will feel gratified

Biggest gain
• We will have patients
who will feel gratified
• Data collected & published results by
optoms will go a long way in recognizing
their potential
• The eye-camps that we participate in can
have reporting as in next slide

Example of eye-camp

What will the optometrist gain
• In today’s times of retail competition & online
sales, service is becoming very important
(because service is not available online)
• Most optometrists who are attached to optical
outlets can add this as a rare service
• Procedure is drug-less therefore there is no
legal binding
• This kind of services add a new flow of footfall
through old patients & through referrals……….

• In today’s times of retail competition & online
sales, service is becoming very important
(because service is not available online)
• Most optometrists who are attached to optical
outlets can add this as a rare service
• Procedure is drug-less therefore there is no
legal binding

• Useful in both imaging of fundus & of eye-
surface

surface
• One can take images of tricky fluorescein-
patterns of CL fitting & send those for opinion

surface
• Eyes can be imaged with cosmetic contact
lenses to demonstrate the performance
• In follow-up of corneal lesions
• To document pre-existing lesions

surface
• Eyes can be imaged with cosmetic contact lenses
to demonstrate the performance
• In follow-up of corneal lesions
• To document pre-existing lesions
• Adds to revenue collection & projects high level
of professionalism

Other conditions
Healed CSR
ByRajeshWadhwa(17Aug2012)

Other conditions
High cup-disc ratio (magnified with software)

Other conditions
Fluorescein pattern of RGP lens trial

Part 2 fundus imaging – presentation for www.eyenirvaan.com

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Part 2 fundus imaging – presentation for www.eyenirvaan.com