Ophthalmologist Dr. Nikolas London and optometrist Dr. Aaron Werner have quite a bit in common. Not only do they both practice in the San Diego, Calif. area and both use Ultra-widefield (UWF) retinal imaging products from Optos in their practices, but they both understand the need for eye care professionals to work together for the overall benefit of their patients.
In this Tech Spotlight, Drs. London and Werner talk about their respective UWF products, their patient and practice benefits, and how these technologies have helped them form a partnership that ultimately allows them to provide better patient care.
The images above represent each of the imaging modalities that optomap devices are capable of capturing (modalities available are device dependent.) Birdshot Choroiditis is represented in each. From left, top row: optomap and optomap af; bottom row: optomap fa and optomap icg.
Dr. Werner — About Daytona
As a primary care optometric practice, we see a wide variety of patients. It is our responsibility to keep healthy eyes healthy, and to diagnose and treat unhealthy eyes. The Daytona allows us to do a quick and thorough screening and assessment of the retina and decide if it requires further attention.
In less than one second, and in one image, I'm able to capture a 200° view of the retina. From a practice efficiency standpoint, it provides a wealth of information in the shortest amount of time. The Daytona is part of our pre-testing protocol with all patients, so when I walk into the exam room my technicians already have the images pulled up on my computer. I am able to quickly assess the retinal images and know right away if I'm dealing with a healthy retina or there's something else I should be focusing the exam on — in this way I can guide the exam from the beginning of the patient encounter.
When it comes to practice benefits, the Daytona is really an easy, straight-forward system to operate. Some retinal imaging products we've used in the past would only give us a photo of the posterior pole and for more detailed imaging we would need to employ a skilled retinal photographer. With the Daytona, I can train anyone in my office within a day or two to take a good picture — they do not need any special photography training.
Additionally, having these images to document a patient's retinal changes are a lot better than my hand drawings and worded descriptions of what I'm observing. Should we ever need to go back and compare images, it's really easy to do.
All of these practice benefits are really patient benefits as well, plus patients love that they do not need to be dilated for the test, so that's a time savings.
However, one of the greatest patient benefits the Daytona allows us to offer is the ability to send the image to a retinal specialist if I need a second opinion. A picture says a thousand words — rather than trying to describe the patient I want to send over, I can send them a Daytona image so they can see exactly what the issue might be.
This is the relationship I have formed with Dr. Nikolas London. I can electronically send him a picture of the retinal image and get quick feedback. If he feels the condition is urgent we can start formulating a treatment plan before the patient even walks through his door.
The Daytona helps us connect all the necessary dots so the patient ultimately wins.
Dr. London — About the 200Tx
The 200Tx UWF retinal imaging device that we have is larger and slightly older than the desktop Daytona, but it captures 200 degrees of the retina and allows for us to perform fluorescein angiography as well. This machine has become an integral part of my daily practice. The numerous advantages include the ability to photograph up to 82 percent of a patient’s retina, no longer needing a trained photographer, a user-friendly interface, and, my personal favorite, gorgeous fluorescein angiograms (optomap fa).
The Optos system provides information that is critical to manage them properly. In patients with peripheral vascular loss due to diabetic retinopathy, Coats’ Disease, or vasculitis, to name a few, the Optos camera not only reveals the areas of ischemia that would be missed with a traditional camera, but it allows me to precisely follow these areas over time. If photocoagulation is needed in these patients, the system enables me to target treatment instead of the less effective type of blanket coverage. Moreover, the camera enables rapid documentation of other peripheral lesions such as tears, vasculitis, choroidal nevi, and hemorrhagic chorioretinopathy that need to be followed before and after treatment, or simply documented over time.
The 200Tx is a non-invasive machine and is quite user-friendly. Technicians can effectively image patients because the device guides you through the process of positioning the patient's head properly in the chin rest and you can move the camera up and down easily with a joystick you hold in your hand.
With the Optos device, patient flow and education is improved as well. Every patient I see in my practice has a retinal image taken with the 200Tx prior to their exam. As soon as I get into the exam room, I can review the image and let the patient know what I see. The images also make great educational tools — I can show patients their entire retina or I can zoom in on different anatomic features to show them exactly what's happening in their retina.
Overall Benefits
By working together, ophthalmologists and optometrists are realizing real patient benefits by using UWF retinal imaging systems from Optos. Doctors in the San Diego community can rapidly share clinically-relevant information about patients that may need a second opinion or that may need to be referred out for treatment. Drs. London and Werner have found that by using these imaging systems to take a photo and send it electronically, they can quickly provide feedback and discuss potential next steps for the patient.
Overall, UWF retinal imaging improves their ability to triage patients and comfort patients and decrease anxiety. For patients who do require additional treatment for any serious issues, it improves their outcomes because they can get them in the operating room quickly.
For more information regarding the benefits of UWF retinal imaging, please visit the Optos website or email the company directly.