instrumental focus

In a Flash

Automated retinal camera efficiently aids in early detection.

Richard C. Buck, O.D.

When it comes to retinal diseases, such as diabetic retinopathy, early detection means the difference between sight and blindness. As a result, it's crucial we employ retinal imaging devices, as their ability to capture large areas of the retina via high-resolution photography can aid us in identifying the signs of early disease. In addition, such technology can motivate patients to comply with our prescribed management because they can actually see their pathology. To accomplish this in my practice, I use the Digital Retinography System (DRS), by CenterVue (www.centervue.com).

Here, I explain why you should consider employing this device in your practice.

Overview

The DRS is an automated nonmydriatic fundus camera that can capture digital photos of the central retina sans pharmacological pupil dilation—it can acquire images through a 4.0mm pupil or smaller, though below 4.0mm image size and quality start to become unreliable. In addition, the device employs a low-powered flash. Patients greatly appreciate these non-invasive characteristics. In fact, I believe these attributes matched with the device's technology have helped me garner several out-of-pocket-pay patients.

In addition to being patientfriendly, the DRS is also practicefriendly in that it's efficient, allowing me to offer it to all my patients without worrying about compromising the appointment schedule. Specifically, it features a motorized chin rest, patient presence sensor, automatic alignment via two pupil cameras, auto-focus (adjustment range −15.00D to +15.00D), autoflash adjustment and auto-capture, producing a digital photo of each eye in less than 30 seconds. (Additional photos require a few more seconds.) Also, the DRS can obtain images in seven different standardized fields at 45°. These fields: superior, superior-temporal, nasal, inferior, temporal, central and central nasal. The device also includes an intuitive 10.4″ touch-screen color display to facilitate the entering of patient information and image viewing. Further, it includes an embedded PC (160 GB hard disk) and comes out of the box Wi-Fi and Ethernet connection-ready, the latter of which enables the viewing of acquired images via networked computers, a laptop and/or an iPad in any of your exam lanes. I share the images with my patients from an iPad. (Some offices are spaceconstrained, so having the ability to hand an iPad to the patient is a big plus.) Finally, the device is compact and portable with dimensions of 22″ x 22″ x 13″ and weighing just 42 lbs.

Testing procedure

Once the patient enters the exam room, the DRS' operator (you or a technician) turns off the lights to enable the patient to achieve natural pupil enlargement. Next, the operator has the patient sit and place his chin on the DRS' chin rest. Because the device is automatic, it requires minimal manual operation. Specifically, the operator sits in front of the device's color touch screen, enters the patient's data (e.g. last name, first name, date of birth, etc.) and presses “start.” The DRS then selfaligns to the designated eye, autofocuses on the retina, adjusts the flash level and auto-captures the image. Then, it automatically moves to the fellow eye.

Once the DRS obtains the images, the operator can manipulate them to view specific areas via the DRS� color touch screen. After the operator manipulates the photo to his or her choosing and captures the manipulated image, she can send it to a designated computer via Internet connection. This way, when you enter the exam room, you have all the information you need to start your portion of the exam.

Staff training

Staff training is comprised of a CenterVue representative demonstrating the DRS' functions to you and your staff. This takes approximately 30 minutes. Because the device is automated and includes an intuitive color touch screen, after staff is educated about what areas and photos are available for capture, operation comes down to simply pressing the “start” button. The company says a “junior high school student can easily be trained in only a few minutes.”

Return on investment

Your return on investment largely depends on how you charge for the service and how often you employ the device. The DRS costs $15,000. Medicare pays up to $62 for a bilateral procedure. The CPT code is 92250. So, if you use the device on roughly 242 Medicare patients, you'll achieve a return on your investment. Mix this with other health insurance plans and patients willing to pay out-of-pocket for the procedure, and you'll get an even faster return.

In my practice, we don't accept Medicare, and we charge an out-of-pocket cost of $12 bilaterally. We've been using the device for three months now, and expect a return in roughly three months. Much of our return has thus far come from out-of-pocket patients.

These patients have been eager to undergo the DRS once the value of the test has been explained. Specifically, our techs educate patients that the device provides a more comprehensive and detailed exam in comparison to the handheld ophthalmoscope. They also educate the patient that dilation isn't necessary, the test is fast and non-invasive, and that the doctor can share the captured images with the patient within minutes. Then, the tech lets the patient know that he may have to pay out-of-pocket for the test. After hearing about all the benefits of the test, the out-of-pocket cost becomes secondary in most of these patients' minds.

Because the DRS is non-invasive, automated and can acquire high-resolution digital images of a wide area of the retina fast, I've found that it's an ideal device for aiding me in the early detection of retinal diseases, such as diabetic retinopathy. OM