Ophthalmic Photography: A Guide.
Ophthalmic photography has a diagnostic imaging role essential to the diagnosis and treatment of a variety of ophthalmic disorders. There are many types of ophthalmic photography/imaging, some of which are:
Fundus Photography
Fluorescein Angiography
ICG Angiography
Optical Coherence Tomography
Slit- lamp (anterior segment) photography
Gonio Photography
Heidelberg Retinal Tomography
Specular Microscopy
Conventional external photography of the eye and orbit
Ophthalmic photography involves the use of complex optical instruments (eg. Fundus Camera System). Each instrument requires specialist knowledge, skills and experience allowing effective operation. Highly skilled hand/eye co-ordination is needed to position the camera and make fine adjustments in focusing, exposure, camera settings and patient eye position. There is an image database specific to ophthalmology for managing images of the patient’s retina, choroid, cornea, iris, lens, lids and the relevant patient details.
Photography can be made difficult by poor pupil dilation, poor fixation, patient light sensitivity, pain, cataracts or poor compliance. The ophthalmic specialty has a predominantly elderly workload and there is a frequent requirement to transfer patients from wheelchairs and assist patients to obtain correct positioning on the cameras. The photographer is frequently required to hold the patient’s eyelids away from the pupil during photography. In all aspects of ophthalmic photography there is risk from direct exposure to uncontained bodily fluids. During ophthalmic angiography (ICG and fluorescein) 5% of patients experience severe nausea /retching/vomiting and some patients faint.
The dye used in the test is injected by a doctor or nurse practitioner and has an inherent risk of severe allergic reaction which can be life threatening and require immediate medical intervention. Nursing and medical staff are not always present for the whole duration of this procedure so responsibility rests on the photographer to call for assistance if symptoms arise. Ophthalmic Angiography sometimes may not be repeated for two days increasing the pressure on the photographer to ensure that a complete record is obtained as delay in treatment could result in sight loss.
The ophthalmic photographer must have an excellent understanding of ophthalmic conditions and these must be considered when undertaking ophthalmic investigation and prioritising patient appointments.
There is significant pressure to produce results quickly.
Words in italics are explained in the accompanying glossary.