Digital Retinal Images of Other Ocular Abnormalities

The Digital Fundus Camera has provided an opportunity for improved patient care because a digital image can be easily acquired and viewed, and compactly stored on disc (see also the digital camera discussion under Macular Degeneration). The digital retinal image can also be easily printed and included in a letter to the referring General Practitioner. Previous to digital cameras, fundus cameras (using 35mm film) were used, but only in hospital eye departments and mainly as diagnostic tools. This was because viewing the retinal images required developing the film, and storing the images was cumbersome, in the form of either colour slides or A4 size sheets of negatives.

In this practice the Digital Fundus Camera was purchased to provide improved diabetic eye care, in particular, as these patients need more frequent and detailed monitoring to rule out retinal changes requiring laser treatment. These patients are photographed at every visit to the practice. Appropriate laser treatment to diabetic eyes has significantly reduced sight-threatening retinal changes, thus significantly reducing blindness among diabetics. Should a query develop regarding the patient's care, the practitioner will promptly refer the patient and include photographs.

Diabetes Mellitus eventually effects the eyes. Diabetes is a blood disorder characterised by chronically elevated blood sugar, which if left untreated, breaks down blood vessel walls, causing leakage of blood fluids. This leakage causes swelling and damage to the tissues affected. Within the eye, leakage causes loss of vision, although the loss is mainly noticed when the macula area of the retina is involved.

Leakage of blood fluids into the retina is called Diabetic Retinopathy, and if left untreated will cause blindness. Diabetic retinopathy is highly variable, depending mainly on how long the individual has had the disease, how old the individual was when diagnosed, how well the blood sugar is controlled, and if there are any other systemic disorders. Furthermore, diabetic retinopathy is an ocular condition which can occur without symptoms. This is why it is very important for all diabetics to have regular eye examinations, because once diabetic retinopathy does occur, it will need to be closely monitored by either an optometrist or a hospital ophthalmologist. Laser treatment has proven to be highly effective in slowing the progression of diabetic retinopathy and preventing blindness.

Below left is a photograph of advanced Background Diabetic Retinopathy. This patient was treated with laser, which resulted in reabsorption of most of the blood and an improvement in vision.

Cancerous tumors can occur anywhere in the body, and the eye is no exception. Below right is a photograph of an ocular tumor picked up on a routine contact lens examination. The patient had been seen yearly for contact lens aftercare appointments for 4 years, is young, in good health, and had no complaints about her eyes. This ocular tumor was detected at her yearly check, and she was referred immediately. She underwent radioactive treatment to the eye, which saved her sight and prevented metastases of the cancerous cells.

High blood pressure (Hypertension) is a prevalent condition, but fortunately it is easily detected and treated. Undiagnosed, hypertension will affect many organs within the body. Long-term untreated hypertension affects the eyes, but rarely causes any disturbance in vision. When the pressure rises within the small vessels of the eyes, it causes the arterioles to harden, and where these arterioles pass over veins, they pinch the venous flow. The pinching of a vein is sometimes total, so that the returning venous blood is stopped. Pressure within the vein continues to rise until the vein can no longer hold the blood and so it escapes into the retina.

The photos below show what can happen with untreated hypertension: Retinal Venous Occlusion. The photo on the left shows a newly developed (superior-temporal) branch retinal venous occlusion (BRVO) with just a small amount of blood leakage. The photo on the right shows a BRVO occurring to a larger vessel. The patient on the left had no noticeable loss of vision, and the patient on the right noticed blurred vision in the eye, which brought him into the practice for an eye examination. These pictures emphasize the importance of regular eye examinations and regular blood pressure checks.

The patient in the photo below left consulted us with a headache which was unresponsive to tablets. His visual acuity (i.e., reading the letters on the letter chart) was very good, and he noticed no problems with his eyes. Examination revealed a swollen optic nerve head secondary to Raised Intracranial Pressure. An immediate referral revealed a brain tumor. The photo shows a blurred view of the optic nerve head, blurred because it is swollen and raised. There are also scattered haemorrhages around the nerve head due to trapped venous blood unable to return because of swelling and congestion in the nerve head. The delicate macula area, however, is free from swelling and leaked blood, and so vision is still very good. A swollen optic nerve causes a loss in vision quality but this loss is not usually apparent to the patient.

The patient in the photo below right complained of a nonspecific disturbance in her vision, headache and slightly blurred central vision. Examination revealed a Retinal Detachment affecting the peripheral retina, which if left untreated would result in blindness. An immediate referral to eye casualty resulted in surgery the next day, and thus no noticeable long-term visual loss. The photo shows an abrupt bend in the vessels on the right side of the retina, and the vessels appear to be overlaying a change in retinal texture: these are the two-dimensional clues of the retina detaching from the wall of the globe. In the consulting room, the optometrist uses a slit lamp with an auxiliary Volk lens to view the detached retina in three-dimensions, which confirms the diagnosis.