The New Age of Retinal Imaging

At a Glance

• Although scanning laser ophthalmoscopy has advantages over traditional fundus photography for retinal imaging, it does not capture true color information.
• The Eidon confocal scanner obtains real color images with automated, dilation-free operation.

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For many retinal conditions, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD), early diagnosis and treatment can help delay or prevent vision loss, slow progression of the disease, and alleviate symptoms.1-7 Diagnosis of these diseases generally begins with visual acuity tests and a dilated eye exam, but many elderly patients are taking tamsulosin or other pharmacologic agents that cause pupil constriction. Others may have had cataract surgery that resulted in anterior capsular opacification, allowing limited visibility of the retina.

Traditional fundus cameras are red-saturated, which may cause images to appear homogeneous or washed out, distorting them and making measurement of the cup-to-disc ratio difficult. Consequently, diagnosing retinal conditions becomes problematic.8

Scanning laser ophthalmoscopy is in many ways superior to conventional fundus photography—it works through smaller pupils using confocal imaging, and it provides better contrast—but it is unable to capture true color information. The Eidon confocal scanner (CenterVue) addresses this deficiency and offers several welcome benefits, which are reviewed in this article.

EIDON: AN OVERVIEW

The Eidon consists of a user-friendly software interface and its intuitive commands allow it to be used in fully automated or fully manual mode. Through the use of a high-resolution, multitouch, color display tablet, it operates as a standalone unit, with local storage of patient information and images. The device’s imaging and viewing features are described in more detail below.

Imaging Modalities

Whereas other confocal scanning systems such as the Spectral OCT/SLO device (Optos) use monochromatic lasers, the Eidon uses white light to provide true color imaging with three confocal imaging modalities: true color (obtained using white illumination), red-free (which can be used to enhance visibility of the retinal vasculature and retinal nerve fiber layer), and infrared (for choroid information).

High-resolution 60° images can be captured even in undilated eyes and without optic bleaching. Because the device can obtain images through a pupil as small as 2.5 mm, it allows capture of excellent images in almost any patient. The white light illumination allows increased perception of retinal pathologies and affords an enhanced view of the optic nerve, providing images that are on par with what would be observed directly. These true color images are essential in determining an accurate diagnosis.

Eidon is also capable of capturing multifield acquisitions, up to 110˚ automatically and 150˚ in manual mode. An option allows multiple images to be stitched together into mosaics to provide a widefield view that enables detection of pathology in the periphery of the retina (Figure).

Other Viewing Capabilities

The Eidon can be used to document pathology including macular degeneration, epiretinal membranes, macular holes, and peripheral lesions. In our general clinic, it doubles as the camera we use to take disc photos for glaucoma. We also use it as a screening tool in the clinic to take images of all patients coming through the door, dilated or not, because screening requires a widefield view. The camera is capable of capturing images in approximately 3 minutes, and this has sped up our patient flow.

Some patients do not require fluorescein angiography but need a fundus photo to document pathology. In such cases, patients can have a fundus image taken with the Eidon platform, which is more staff- and time-efficient and helps cut the cost of staff overhead.

Image Sharing Near and Far

Eidon’s touchscreen tablet interface is built to communicate with an office’s computer system so that images taken with the scanner can be accessed from any computer with an Internet connection. This is helpful in educating patients because one can bring up images on any Wi-Fi–capable tablet to better explain their pathology and what treatments will be necessary to combat the condition.

The remote viewing function also makes this technology ideal for telemedicine applications, as primary care physicians in rural areas can upload captured information for a retina specialist to review, enabling early disease detection.

A PRACTICAL CHOICE

Most cameras require operation by a highly skilled technician, but the Eidon will walk patients through the exam. It features automatic pupil alignment and retinal focusing, allowing any staff member to efficiently run tests. Specifically, it auto-aligns to a patient’s pupil; focuses the retina; and captures images, both infrared and color, using a soft light source to ensure patient comfort. If necessary, it is also possible to switch to manual mode and use a virtual joystick to focus and align with specific areas to capture particular pathologies in greater detail.

While similar devices on the market such as the Daytona (Optos) may provide comparable results, in my experience the Eidon is easier to use in terms of patient positioning and image capturing, and it is less than half the cost. For these reasons, this confocal scanner has been a welcome addition to our practice. n

Farrell C. Tyson, MD, is an ophthalmologist at Tyson Eye in Cape Coral, Fla., and a clinical investigator for numerous US Food and Drug Administration studies. He has no disclosures relevant to the content of this article. Dr. Tyson may be reached at tysonfc@hotmail.com.

Your optometrist has many ways to identify issues with your eyes, including vision problems and eye diseases. They use technology during your eye exam to help identify and treat a range of eye conditions. An essential part of your eye exam is an eye health evaluation that involves retinal imaging. 

Retinal imaging can help detect many eye conditions, including macular degeneration, diabetic eye disease, glaucoma, and retinal detachment. Performing tests for these conditions can help protect your eye health and overall wellness. 

What Is Retinal Imaging? 

Retinal imaging helps your eye doctor see the inside of your eye in detail. Essentially, your optometrist takes a photo of the internal structures of your eye, including the retina, optic nerve, macula, and surrounding blood vessels. The image your optometrist takes helps them diagnose potential problems like eye diseases. 

Depending on your needs, your eye doctor may use different types of retinal imaging.

Why Do You Need Retinal Imaging? 

Retinal imaging is a part of many standard comprehensive eye exams. It’s essential for getting an in-depth look at the structures of your eye. Even if you can see well, your eyes may still be developing new conditions—many eye diseases develop with limited symptoms. 

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These conditions may not show symptoms until they affect your vision. Booking regular eye exams can help protect your eye health. 

Retinal imaging lets your eye doctor see the inside of your eye clearly and effectively, helping them identify eye disease as early as possible. The sooner they identify an issue, the faster they can recommend a treatment plan to protect your vision. 

What Can Retinal Imaging Detect?

Retinal imaging can detect many eye diseases that go unnoticed by the naked eye. This technology captures detailed images that help your optometrist identify problems they may not notice otherwise. 

Some of the conditions and diseases retinal imaging can help detect include age-related macular degeneration, diabetic eye disease, glaucoma, and retinal detachment. 

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) occurs when the macula, the part of your eye responsible for central vision, begins to thin. This condition can develop naturally with age, affecting your ability to see what’s directly ahead of you. 

There are 2 forms of AMD: wet and dry. Treatment for this disease depends on the kind you have. Individuals with AMD typically develop the dry form first, which can progress to the wet form. 

Diabetic Eye Disease

Diabetic eye disease is a general term to describe eye problems that develop because of diabetes. In general, diabetes increases your risk of several eye conditions, including glaucoma and cataracts. 

One disease specific to diabetes is diabetic retinopathy, which occurs when blood vessels in your retina, the thin layer of tissue in your eye responsible for sending signals to your brain, begin to swell and leak into the eye. 

High blood sugar can cause issues with the blood vessels in the retina, causing fluid and blood to leak. As this disease progresses, it can lead to vision loss, scarring, and other complications. 

Glaucoma

Glaucoma is a group of eye diseases that damage your optic nerve, an essential part of your eye necessary for sight. Many forms of glaucoma increase intraocular pressure (IOP), damaging the optic nerve. With time, this disease can lead to severe vision loss. 

Glaucoma is a leading cause of blindness in adults over 60, making regular eye exams essential for protecting your vision. Depending on its form, glaucoma may not present many symptoms until vision loss begins. Your optometrist uses retinal imaging during your eye exam to identify early signs of glaucoma. 

Common types of glaucoma include: 

Retinal Detachment & Tears

Retinal detachment is an emergency. It occurs when your retina pulls from its natural position in the eye. Detachment removes the retina from oxygen, increasing your risk of vision loss the longer the eye goes untreated. 

Your eye doctor can diagnose retinal detachment by completing a comprehensive eye exam. They look at the back of your eye to identify holes or tears in the retina. 

There are several signs you may have a detached retina: 

• The sudden appearance of floaters in your vision
• Blurry vision
• Reduced peripheral vision
• A shadow over your visual field
• Flashes of light 

Eye Cancer

Cancer can either start in the eye or spread to the eye from another part of the body. The most common type of eye cancer is intraocular melanoma, cancer that forms inside the eye. 

While cancer can develop in the conjunctiva, a clear tissue covering the inside of your eyelid, it more commonly develops in the uvea. The uvea is the middle of your eye, and cancer can form in the iris, the muscles in the eye, or near the retina. 

Your optometrist can use retinal imaging to help identify early signs of cancer. 

Damage from High Blood Pressure 

High blood pressure can negatively affect your health, including your eyes. This problem typically occurs due to diabetes, high cholesterol, or smoking. Thankfully, retinal imaging can help catch this damage. 

High blood pressure can damage blood vessels in your retina and increase your risk of other complications. You’re at more risk of damage the longer you have high blood pressure. 

Protect Your Eye Health & Vision

Your vision is precious, and retinal imaging is essential for protecting your sight. It’s one of the many tools your optometrist has to care for your eye health and vision. Book your next eye exam, and your eye doctor can complete a detailed examination. 

Contact Park Slope Eye when it’s time for your next eye exam.

For more information, please visit Laser Retinal Imaging.