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The Positive Effects of Wide Field Imaging

The Positive Effects of Wide Field Imaging

Does Anything Happen Outside the Posterior Pole?

The peripheral retina looms as uncharted territory in many eye care practices. Even with effective dilation protocol and examination with binocular indirect ophthalmoscopy, the patient’s cooperation becomes a limiting factor in the discovery of a number of potentially sight-threatening issues. This report summarizes the positive “hit rate” of employing wide-field imaging in a private, two-doctor practice in Tyler Texas over a period of June 2013 to November 2013.

 Editorial Assistance from Larry J Alexander OD and Elizabeth Brewer

 

Office Protocol

The basic protocol followed in the office is:

STANDARD OF CARE IS TO OBTAIN WIDE-FIELD RETINAL PHOTOS WITH SIX GAZES ON ALL OF THE FOLLOWING PATIENT CLASSES:

  1. High myopic patients
  2. First-time patients
  3. Medicare (65+) patients
  4. Positive patient history and/or family history of retinal disease
  5. Patients with complaints of VA disturbances…e.g. flashes and floaters

THE SIX GAZES INCLUDE:

  1. Straight on standard image
  2. Detailed image of optic nerve and macula
  3. Superior gaze image
  4. Inferior gaze image
  5. Nasal gaze image
  6. Temporal gaze image

An attempt is made to hold the lids as much out of the way as possible

Statistics From the Practice

Following the above protocol, an assessment was made of the number of patients discovered with relevant sight-threatening retinal disorders occurring in the retinal periphery.  The results are listed in the following table with the interventive action applied by the retinal consultant.  Thirty patients received peripheral retinal consultations between June 2013 and November 2013 based on the wide-field six-gaze imaging protocol employed by the practice. 

Positive intervention was applied in 19 of 30 or 63 % of all wide-field imaging with monitoring in 11 of 30 or 37%. Confirmation of the validity of the consultation occurred in 100% of cases.  Some examples of the images follow in the accompanying Atlas.

 

Diagnosis

Intervention

1

Lattice Degeneration with Retinal Holes

Barrier Laser

2

Horse Shoe Tear

Barrier Laser

3

Retinal Tear

Barrier Laser

4

Retinoschisis OU
Retinal Tear

Barrier Laser

5

ERM
Retinal Tear

Barrier Laser

6

Retinal Holes
Intraretinal Heme

Barrier Laser

7

Retinal Holes

Barrier Laser

8

Retinal Lattice with Multiple Atrophic Holes

Monitor and Signs and Symptoms of RD

9

Lattice Degeneration with Horseshoe Tear and Operculated Tear

Barrier Laser

10

Retinoschisis with Vitreous Membranes and Strands

Monitor and Signs and Symptoms of RD

11

Lattice Degeneration with Holes

Monitor and Signs and Symptoms of RD

12

Lattice with Multiple Retinal Holes with Subretinal Fluid

Barrier Laser

13

Horseshoe Tear with Vitreous Heme

Barrier Laser

14

Lattice Degeneration Retinal Tear OU

Recommended Barrier Laser but Patient Opted for Monitor and Signs and Symptoms of RD

15

Lattice Degeneration
Atrophic Holes

Barrier Laser

16

Retinoschisis Lattice Degeneration
Retinal Holes

Monitor and Signs and Symptoms of RD

17

Retinal Hole with Subretinal Fluid
Lattice Degeneration

Barrier Laser

18

Lattice Degeneration
Retinal Tear OD with Subretinal Fluid

Barrier Laser

19

Retinal Hole with Subretinal Fluid

Barrier Laser

20

Retinal Holes Within Lattice Degeneration

Monitor and Signs and Symptoms of RD

21

Retinal Tears and Lattice Degeneration

Barrier Laser OU

22

Peripheral Retinal Hemorrhages
S/P Barrier Laser

Carotid Duplex Studies

23

Retinal Detachment Giant Retinal Tear

Pneumatic Retinopexy

24

Lattice Degeneration
Retinal Tear

Barrier Laser

25

Retinal Hole in lattice Degeneration

Monitor and Signs and Symptoms of RD

26

Retinal Tears s/p Laser
Retina Detachment s/p Laser

Monitor and Signs and Symptoms of RD

27

Lattice Degeneration
Multiple Holes
VR Tuft with Tear

Barrier Laser

28

s/p Laser Horseshoe Tear

Monitor and Signs and Symptoms of RD

29

MEWDS

Monitor

30

Hollenhorst Plaque

Cardio Vascular History
Monitor

Of particular importance in analysis of this data is the fact that 29 of 30 or 97 % of the cases were discovered at an early phase of development and were able to be treated with non-invasive laser barrier treatment or careful monitoring with Signs and Symptoms of Retinal Detachment emphasized. 

Atlas of Photos

FIGURES 1 AND 2:  LATTICE DEGENERATION AND RETINAL HOLES

image1

 

image2

FIGURE 3:  RETINOSCHISIS AND RETINAL HOLES

image3

FIGURES 4: RETINAL HOLE

image4

FIGURES 5 AND 6:  LATTICE DEGENERATION AND RETINAL HOLES OU

image5

image6

FIGURES 7 AND 8: HORSESHOE TEAR

image7

image8

FIGURE 9: RETINOSCHISIS

image9

FIGURE 10: LATTICE WITH MULTIPLE RETINAL HOLES

image10

FIGURE 11: LARGE HORSESHOE TEAR

image11

FIGURES 12 AND 13: LARGE RETINAL HOLE WITH EDEMA SURROUND

image12

image13

FIGURE 14:  LATTICE DEGENERATION WITH HOLES

image14

FIGURE 15:  LATTICE DEGENERATION, WWOP AND RETINAL HOLE

 image15

FIGURE 16: LATTICE WITH HOLE

image16

FIGURE 17: RETINAL HOLES AND LATTICE DEGENERATION

image17

FIGURES 18 AND 19: s/p BARRIER LASER AND PERIPHERAL RETINAL HEME

image18image19

FIGURES 20 AND 21: LATTICE AND TEAR

image20image21

Conclusion

In this Tyler Texas practice, Wide Field Imaging has proven to be very effective in the primary eye care environment in regard to discovering peripheral retinal disease.  The implemention of wide field imaging and careful dilated peripheral retinal examinations in the primary care optometric office can offer the patient early intervention in potentially vision threatening diseases.  Attention must be paid to the details of obtaining the images such as the six-field gaze protocol of this practice.  

 

Wednesday, 04 December 2013 Written by Dr. Ronald Smith – Optometrist, Dr. J Mark Hooton - Optometrist Posted in Philosophy/Editorials

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About the Author(s)

Dr. Ronald Smith – Optometrist

Dr. Ronald Smith – Optometrist

Dr. Ronald Smith attended Tyler Junior College, Texas A & M and is a graduate of the College of Optometry at the University of Houston. Ron first practiced in Garland, TX then opened a practice in Tyler TX in 1976. Dr. Smith taught in the ophthalmic assistant program at Tyler Junior College. Ron and Rebecca are the parents of five children. Ron is not only a medically-focused optometrist but has also been very active in the community.


Dr. J Mark Hooton - Optometrist

Dr. J Mark Hooton - Optometrist

After serving in the United States Marine Corps, Mark attended Texas A&M University. He graduated in 2001 with his Bachelors of Science degree in Biomedical Science. While attending A&M he played rugby and was selected to the Texas Collegiate All-Star Rugby Team.

Upon graduation from A&M Dr. Hooton attended NOVA Southeastern University in Ft. Lauderdale, Florida. In May 2005, he graduated with his Doctor of Optometry degree. He then became certified as a Therapeutic Optometrist, Optometric Glaucoma Specialist and Optometric Physician in July of the same year. He has worked alongside one of the most experienced LASIK surgeons in the world, and he has personally been involved in managing over 20,000 surgical procedures.

When Dr. Hooton is not in the office he enjoys spending time with his wife, Krissy and their two daughters.

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