Recognizing the Importance Of Widefield Imaging
Documenting retinal health is more important than ever before. Here's what you need to know to protect your patients and your practice.
By Carmen A. Puliafito, M.D., M.B.A., Miami

The U.S. Census Bureau projects the number of Americans age 65 and older will double by 2030. More older patients means a rising incidence of age-related vision-threatening diseases, including diabetic retinopathy, age-related macular degeneration (AMD) and glaucoma. Now, more than ever, we need a quick, reliable imaging system to monitor this growing population's retinal health.

Documenting retinal health

The methods we currently use to examine our patients' retinas have their own unique drawbacks. Dilated examinations reveal the entire retina, including the periphery, but you must record the results by drawing a color diagram in the patient's chart. Fundus cameras produce a more objective, permanent record of retinal morphology, but they can be difficult to use and capture only a small portion of the central fundus.

Ultra widefield imaging technology, like the Optomap Panoramic200 scanning laser ophthalmoscope, lets us examine and document retinal health without compromise.

Quick, convenient widefield imaging benefits two important areas of ophthalmology:

► Disease detection. To detect disease effectively, retinal image quality must be excellent, highly detailed and easy to analyze.

► Documentation. Keeping complete patient records has become a huge issue for eyecare professionals, especially over the past 5 years. Good documentation makes financial sense: You won't get paid if your records are incorrect or incomplete. And if you ever find yourself in a courtroom, you'll be glad to have good records at your disposal.

Optomap image showing retinal hemorrhages in a patient with diabetic retinopathy.

Saving sight

New treatment options for two of the leading causes of blindness in Americans 65 and older reinforce the importance of routine retinal examinations.

Affecting more than 5.3 million people older than 18 years, diabetic retinopathy is a particularly debilitating consequence of uncontrolled diabetes. Sustained high glucose levels and chronic hypertension can weaken retinal blood vessels, causing bleeding. Left untreated, patients develop neovascularization that blocks light from reaching the retina. Fortunately, we can treat diabetic retinopathy with laser trabeculoplasty and vitrectomy, making it more important than ever to detect this condition at an early stage.

Another retinal disease that benefits from early detection is AMD. Data from the Age-Related Eye Disease study show that a program of high-dose antioxidants and zinc can slow disease progression in patients with intermediate or advanced AMD. Early detection means more expedient therapy, potentially helping patients retain their sight longer.

In addition, once a patient is diagnosed with AMD, widefield retinal imaging is invaluable for detecting and tracking macular changes.

LASIK and retinal health

Retinal disease predominantly affects people over the age of 50, so why would a LASIK surgeon, whose average patient is 40 years old, need an automated retinal image system in his office?

When assessing candidates for LASIK, surgeons do screen patients for retinal disease, but they generally focus on measuring and examining the cornea. Obviously, no surgeon will perform LASIK on a patient with retinal pathology, but refractive surgeons seem to have forgotten that myopia, one of the leading reasons for LASIK, is a retinal disease.

LASIK isn't an independent risk factor for retinal detachment, nor does it increase a patient's risk of retinal detachment. Simply put, myopic patients are more likely to have retinal detachment because of the shape of their globes.

However, the temporal relationship between LASIK and retinal detachment can suggest causality to a patient -- or his attorney -- so it's important to tell myopic patients why they're at risk. For documentation purposes, you should thoroughly examine and record every patient's fundus periphery before scheduling LASIK, either by conducting a manual examination and sketching your findings or by examining the retinal periphery with an automated instrument, such as the Optomap.

Why automated?

Effective documentation is routine, easily stored and quickly retrieved; never easier than with a reliable automated instrument. Refractive surgery practices can particularly benefit from an automated retinal imaging system, such as the Optomap, because:

• Surgeons can evaluate the retina without dilating the patient's eye, leaving them free to focus on procedure planning.
• The Optomap's clear digital images capture the retinal periphery, helping surgeons screen out inappropriate LASIK candidates.
• Surgeons have a permanent record of retinal disease and the risk of retinal detachment before doing surgery.

Looking ahead with digital imaging

Aside from the obvious advantages of efficiently documenting and detecting disease, automated retinal imaging elevates the quality of care you provide for your patients.

This supplement investigates how we can best use ultra widefield technology, alone and in conjunction with traditional retinal imaging techniques, to keep our patients and our practices healthy.

Dr. Puliafito is the director of the Bascom Palmer Eye Institute in Miami.