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PHOTO FINISHES

A SALUTE TO FUNDUS PHOTOGRAPHY

ALAN GLAZIER, O.D., F.A.A.O.

DIAGNOSTIC TECHNOLOGY enables us to see both further out and deeper into the eye, providing perspectives that allow for the early detection of ocular disease and the identification of the most appropriate management.

Here are posts illustrating pathology realized through modern diagnostic imaging technologies.

A FOCUS ON THE FUNDUS

One “ODs on Facebook” member wrote about a 49-year-old patient who presented to her office complaining of gradually worsening distance and near vision since he underwent LASIK three years prior. She said the patient’s medical history was unremarkable, and his entrance testing was within normal limits with only mild, compound myopic astigmatism OU. His BCVA was 20/25 OD and 20/20 OS, and the patient’s cornea had scarring consistent with a radial keratotomy (RK) OD and LASIK OU. Also, mild lens changes were noted.

Dilated fundus exam revealed two pigmented atrophic holes OD (not concerning), a posterior vitreous detachment, a superior nasal horseshoe tear and surrounding subretinal fluid OS. This fluid extended further laterally upon digital retinal exam. The doctor wrote that the patient denied flashes or any new/changing floaters. She said she immediately referred him to a retinal specialist who notified her the patient had scleral buckling, but a “good” outcome.

Clinical image of the 78-year-old man.

This post received 80 likes and no comments.

CONDITIONS REVEALED

Another member of “ODs on Facebook” happily posted that her newly purchased digital fundus camera aided in the diagnosis of normal tension glaucoma (NTG)and an epiretinal membrane in a 68- year-old woman who underwent RK and had posterior chamber lenses.

This post received 65 likes and 29 comments. Examples of comments:

• “Great pics! Nothing replaces a good fundus camera. . . “

• “Lovely photo, what is the ballpark price??”

LOTS OF PROBLEMS

Yet another “ODs on Facebook” member showed the fundus images of a 78-year-old man who has a history of a vitreous hemorrhage post-op cataract surgery, a retinal tear, branch retinal vein occlusion, a macular hole and strabismus. The patient’s IOPs were 18/12mmHg. Despite his ocular problems, the patient’s BCVA was 20/25 OU. The doctor was able to identify a beading artery inferior pole and an enlarged cupping and pallor with the camera’s aid. He ordered a visual field test and an OCT.

This post received 23 likes and 17 comments. Examples of comments:

• “His visual field and his OCT are almost guaranteed to be abnormal with that fundus. . . Pending the results, I don’t think it’s wrong to treat. Lowering the IOP could have an added beneficial effect on retinal blood flow. . . ”

• “Tell [the] patient to enjoy every day as if it was his last!! With all that history he’s lucky he can see!” OM

DR. GLAZIER is founder of Shady Grove Eye and Vision Care, a five-doctor medical-model practice in the Rockville, Md., suburbs of Washington DC. He is an author, inventor, industry consultant and frequent lecturer on ocular disease and Internet marketing. He can be reached at aglazier@youreyesite.com. Be sure to follow him on Twitter @EyeInfo or PM him on Facebook.