A 32-YEAR-OLD female presented to my clinic for a routine hydroxychloroquine sulfate (Plaquenil, Sanofi-Aventis) toxicity screening, at the recommendation of her rheumatologist. The patient had a history of lupus and had been taking 200 mg b.i.d. of the drug for seven years. In addition to a complete dilated retinal examination, we utilized the EIDON AF, from CenterVue, to look for early evidence of ocular toxicity.

OVERVIEW

The Eidon AF is a fundus autofluorescence (FAF) device that illuminates lipofuscin, a protein released by the retina when it becomes damaged and is instrumental in the diagnosis and management of retinal diseases, such as hydroxychloroquine toxicity, central serous retinopathy (CSR) and geographic atrophy (GA).

The revised recommendations on screening for hydroxychloroquine retinopathy, by the American Academy of Ophthalmology, advise screening patients who take the drug with SD-OCT, multi-focal electrogram or FAF, as these technologies can aid in the detection of ocular changes before they become visible in the fundus.

PROCEDURE

The EIDON AF is a multi-modal imaging device that has three imaging options: visible light, infrared or FAF.

Choose the modality you prefer and the area, or areas, of the retina you wish to examine on the unit’s tablet, and begin.

The unit has two modes, automated and manual. I use the automated mode almost exclusively. Quality, 60° images can be obtained through undilated pupils, down to 2.5 mm. After the images are captured, a mosaic pattern can be formed using the images of your choice.

These images can either be viewed on the tablet or on an associated monitor with the standard remote viewer for enhanced viewing. The process takes about three to four minutes.

TRAINING

The unit is fully automated and intuitive. A representative can train staff on the device’s operations in about an hour.

PRACTICE BENEFITS

FAF is helpful in a variety of disease processes, such as CSR and hydroxychloroquine toxicity. Further, it can aid in determining the likelihood of GA progression.

Images are billed and reimbursed as standard retinal photos (92250), with the appropriate coding.

PATIENT BENEFITS

The patient thankfully had a normal FAF. We notified the rheumatologist of our findings; the patient was advised of her eye health and to return next year for continued monitoring. By utilizing the new EIDON AF technology, we upheld the recommendations from the AAO and gave this patient the best care possible. OM

DR. FERRUCCI is chief of Optometry at the Sepulveda Campus, West Los Angeles Department of Veterans Affairs and a Full professor at the Southern California College of Optometry at Marshall B. Ketchum University. He is a fellow in The AAO as well as the Optometric Retina Society. He currently serves as vice president of the ORS, as well as chair of the Academy’s Special Interest Group in Retina. He is an advisor to CenterVue.