instrumental strategies

Imaging Made Easy

Digital fundus camera enables more time for patient education.

JAY W. HENRY, O.D., M.S.

State-of-the-art patient care and education are integral to a successful practice. Often times, however, many of us are forced to provide abbreviated patient education because the accurate operation of our diagnostic devices monopolizes our time. The good news: I've discovered, that the TRC-NW8 non-mydriatic digital retinal camera, from Topcon, not only enables me to provide excellent patient care, but spend more time educating patients regarding their ocular anomalies, as a result of the device's various timesaving features. This, in turn, has enabled me to improve patient compliance to my prescribed treatments.

Here, I discuss these features.

► Automation. Much of the TRC-NW8 is automatic. For instance, by pushing the "D" (disc), "C" (central disc and macula) and "F" (fovea or central macula) buttons, the device activates a green patient fixation light that causes the patient's eye to be positioned in such a way that the captured photo centers on the aforementioned desired part of the retina.

Also, the TRC-NW8 uses its autofocus and autocapture feature to make it almost impossible to obtain substandard photographs.

In addition, the camera boasts stereo photography capabilities as well as eight peripheral fixation lights that you can use to obtain the cardinal points of gaze up, up/right, right, down/right, down, down/left, left, up/left. These fixation lights provide you with reproducible photos of each quadrant of the eye — excellent for comparison purposes or for a research project, in which you desire a set pattern.

► Built-in optical green filter. The camera doesn't exclude red and blue pixels to achieve a green image, but instead uses a real optical green filter on the image. This enables red-free image acquisition (commonly used to view the nerve fiber layer in glaucoma patients, subtle retinal hemorrhages or to distinguish choroidal nevi from more serious melanomas). As a result, you receive a high-quality, high-resolution image, without having to manipulate the photo yourself via software to make it red-free.

TRC-NW8 HEIGHT:: 530 mm WIDTH: 272 mm LENGTH: 505 mm WEIGHT: 24.5kg COST: $22,000 to 26,000.

► Small pupil identification. The TRC-NW8 can capture a photo through a pupil as small as 3.3mm without diminishing image quality. An added bonus: The camera automatically decides when to switch to the small pupil function, although you can operate this function manually as well. Patient dilation can take 15 to 30 minutes post-drop. Therefore, having the ability to take photos without always having to use mydriasis not only saves me time for patient education, but also makes the phototaking process more comfortable for the patient.

In addition, if you've already instilled drops but the patient's dilation is small, this feature enables you to still obtain the photo you desire.

► Nine levels of illumination. The device enables you to adjust the brightness of the acquired image, if needed, via nine levels of illumination through the push of a button. This has enabled me to save time in that, again, I don't have to import the image into separate software to manipulate the photo's brightness.

► EyeRoute on board system option. The EyeRoute system allows you to view camera-acquired retinal images at any of the several workstations in your office, or, in fact, at any other place that has Internet access. This is because the system keeps the photos on one secure web-based location, where you or anyone else authorized to do so can view them. This is an enormous convenience for any practitioner (most of us, I think) who has spent a great deal of time downloading, printing, scanning, filing and e-mailing bulky photo files.

In addition, the system includes photo comparison/viewing abilities, enabling you to manipulate and view the /archive/2008/October/images/patient reports the way you desire. The system comes pre-installed and ready to try, via a separate fee, on all Topcon non-mydriatic cameras.

We used to reserve fundus photography for pathology — those patients having or suspected of having diabetic retinopathy or glaucoma. But now we are transitioning into storing digital fundus images of all our patients because the TRC-NW8 has provided the ease of use and technology to do so. The minimal effort to acquire these photos is worth it for those cases in which an otherwise undetected retinal change, such as an alteration in the cup-to-disc ratio, has occurred.

The TRC-NW8's automation, built-in optical green filter, small pupil identification feature, nine levels of illumination and EyeRoute on board software option have given me a luxury I never thought possible for any practitioner — time. And, thanks to this new extra time, I've been able to fully educate my patients on their condition and need for prescribed treatments. This has improved patient care and compliance. OM