instrument focus

Hey Man, Nice Shot

Retinal camera offers stereo image in one take.

Marc Greenberg, O.D.

Having worked in a busy optometric practice for more than 20 years, I have learned that my patients' time is precious, so they are always grateful for fast chair time. This is one of the reasons I purchased the WX-3D Retinal Camera, from Kowa Optimed, Inc.

Overview

Kowa's WX-3D Retinal Camera is a non-mydriatic retinal camera/analysis system that offers either 2D or 3D stereoscopic photography in one shot.

For 2D photos, the camera's optical design allows the operator to capture images in normal and small pupil modes with a field angle of 45°. It uses a 12 megapixel digital DSLR (digital single lens reflex) camera for very detailed images, and an integrated fixation system allows the operator to create a mosaic from the photos to produce one image that covers a large area.

For 3D images, the WX-3D produces a 3D photo of the optic nerve in one shot, capturing a 20” x 27” field of view as a stereo image.

Being able to acquire 2D and 3D stereo images in just one take, even on small pupils (e.g. 3mm to 4mm), are attributes that save chair time. To start, the operator doesn't need to move the camera 15° one way, take a photo and then move it 15° another way. He/she simply lines up the patient once to the camera, and takes the photo with one click. Second, the operator doesn't have to dilate the patient for the purposes of taking the photo. The end result: My retina pathology suspects and retinal disease patients are able to leave the practice within 15-to-20 minutes.

Being able to acquire 2D and 3D stereo images in just one take — and to do so on small pupils (e.g. 3mm-to-4mm) — are attributes that save chair time.

The camera integrates with one's EHR system through Kowa's VK-2 software. So, once the operator acquires the image, within seconds it appears in the patient's electronic file. And, I can call it up on the computer screen in my exam room to educate the patient - even if he has no particular pathology. If a patient is able to see it for himself, he'll be able to have a better understanding of his current situation. Patient education is invaluable, as it helps me generate conversations with patients on potential risks to their vision, and drive home the importance of follow-up and routine eye exams.

Procedure

When preparing patients for the camera, dilating the eyes is not always necessary, it can help when in the small pupil mode. In six simple steps, we can quickly capture a high-quality retinal image:

1. Position the patient's chin in the chin rest of the camera.
2. The operator selects the photography mode: “Normal,” “Small Pupil” or “Stereo.”
3. The camera displays an Anterior Segment Alignment picture on the display. The operator positions two brackets over two working dots projected on the cornea.
4. The operator then presses the “Anterior Segment” button, and the retina appears on the display.
5. On the display, two lines appear on the patient's retina. The operator must make sure the lines are collinear, which then means the camera is in focus and ready to take the photo.
6. The operator pushes the joystick trigger (shutter button) to take a photo of the patient's retina.

Training

A Kowa sales representative supplied a short training session in our office. Within about two hours, the representative set up the camera and imaging system, connected it to our computer system and trained the staff on how to operate the camera. After using the WX-3D just once, my staff was able to use the camera.

Since installing the camera in my office, I have successfully used Kowa's phone support for any problems I have had. Additionally, Kowa's support staff can log on to the camera's computer system remotely to fix any issues we may have.

Return on investment

Being in a medical optometry practice, we see a lot of glaucoma suspects and macular degeneration patients. In order to do medical evaluations and treatments, you must have the right equipment or you end up referring these patients to someone who does. Why not capture all these patients by being able to treat them yourself?

On average, I use the camera on between two-to-three patients each day, and the reimbursements add up. The price of the Kowa camera was in the low-to mid-$20,000 range. In New York state through Medicare code 92250, I receive $80 in reimbursement for each patient, for about $1,000 in extra revenue each week, which covers the cost of camera in less than a year.

Additionally, the camera can also be used as a general screening device, which can also be an additional source of revenue.

In summary, the WX-3D Retinal Camera produces an image that allows me to provide a diagnostic explanation to my patient. Additionally, it allows my existing staff to capture high-quality stereo optic nerve and wide field (45°) images with no special training. OM