instrumental strategies

Retinal Disease Detective

Device aids in early retinal disease detection and boosts practice efficiency.

JOHN DESMONE, O.D.

Because we, as optometrists, see numerous patients throughout the day, we greatly value any technology that not only aids us in patient care, but also boosts the efficiency of our practice. This is where the AFC-210 (automatic fundus camera) Pro Photographer, from Nidek, comes in to play.

The device aids in the early diagnosis and monitoring of retinal conditions, disorders of the macula and optic-nerve disease — allowing me to prescribe treatments to prevent vision loss. In addition, the instrument has increased the efficiency of my practice through its ease of use, convenient features and clear images.

Retinal disease diagnosis

The auto-focus, auto-alignment non-mydriatic fundus camera portion of the AFC-210 includes a 5.7-inch thin-film transistor (TFT) liquid crystal display (LCD) (640 × 480 resolution) monitor, an optic system and a charge-coupled device (CCD) camera to confirm the status of the eye's anterior segment prior to photography.

The device then captures true 45° images of the retina, without cropping, in 12.8 mega-pixels. These features provide a clear and detailed display of the fundus image, so you can best identify retinal pathology. When central fixation isn't possible for the AMD patient or you're unable to capture a peripheral retinal finding, you can use the instrument's external fixation light to accomplish these tasks.

The AFC-210 also offers stereo-disc photography, which enables me to view the depth and three-dimensional aspect of the optic nerve. This is important for monitoring disc changes in glaucoma and determining treatment options.

AFC-210
HEIGHT: 20" WIDTH: 11" LENGTH: 19.9" WEIGHT: 55 lbs. FOOTPRINT: 11" by 19.9" COST: $22,000 to $27,000

The software portion of the device, known as the Navis-Lite (Nidek Advanced Vision Information System) data filing software, offers several features that aid in retinal disease early detection. It allows you to zoom in and rotate an image at any angle to identify pathology. In addition, the software enables you to process images with red, green and blue channels or with a red-free filter for contrast. These filters separate retinal layers, enabling a definitive diagnosis.

Further, Navis-Lite includes a seven-image mosaic that you can combine to create a panorama of the fundus. This provides a wider field of view of the retina, so you can ensure you're seeing everything you need prior to making a diagnosis.

The software's measurement tools enable you obtain optic disc size as well as cup-to-disc (C/D) ratio data and to take exact measurements of retinal pathology, such as a choroidal nevus, and superimpose them on the image. These measurements allow you to monitor the pathology's progress, which determines treatment.

Also, if there's something about a particular image that you want to remember, the software includes a drawing tool that allows you to add labels and arrows. Finally, you can e-mail images, should you want to consult with a colleague or retinal specialist.

Practice efficiency

After just a few minutes of training, our entire staff learned how to take high- resolution digital images. This is because the AFC-210 basically works on auto-pilot. The operator (you or a staff member) aligns the patient in the device's headrest and adjusts the chinrest via an "up-down" button. The operator then maneuvers the joystick to the proper position. When the AFC-210 automatically switches from a corneal to a retinal image, the operator presses the capture button on the top of the joystick. Voila, your fundus image is captured.

The Navis-Lite software has been very easy to learn and navigate. In fact, I've learned most of its components via experimentation. In other words, I've yet to open the device's manual. This is because the software includes easily recognizable operations, such as "save" and "capture."

One great feature is the software's ability to be loaded into each networked computer workstation. This enables me to review images with the patient in the exam lane — something that has not only been a great educational tool, but has also improved practice efficiency and saved me time. How so? My explanations regarding my findings don't have to be as long-winded because the photo basically does the talking for me. I then e-mail patients the photo with a description, as they like to keep tabs on the progress of their condition.

We want to provide the best care to our retinal-disease suspects and patients. And, we're always looking for ways to improve the efficiency of our practice. The AFC-210 is definitely worth a look, as I've found it meets both these goals. OM

JOHN DESMONE, O.D., IS A 1991 GRADUATE OF THE INDIANA UNIVERSITY SCHOOL OF OPTOMETRY AND HAS BEEN IN PRIVATE PRACTICE IN HAVELOCK, N.C., WITH HIS WIFE BARBARA DESMONE, O.D., FOR THE PAST FIFTEEN YEARS. HE CAN BE REACHED AT DESMONEEYE@EC.RR.COM.