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Ophthalmoscopy, optic disc photos essential in glaucoma evaluation, management
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PRAGUE — Fundus photography remains essential in the diagnosis and follow-up of glaucoma. Imaging cannot capture all signs and should therefore complement but not substitute clinical examination, according to one specialist speaking at the European Glaucoma Society Congress.
Thierry Zeyen, MD, PhD, mentioned several studies demonstrating that expert ophthalmologists and optometrists with a special interest in glaucoma were able to assess optic disc photos with equal or even greater precision than HRT, GDx or OCT.
Thierry Zeyen
“Precision improved with severity of the disease and also with training,” Zeyen said. Across studies, higher qualifications and special interest in glaucoma were factors related to higher precision. In a study performed by his own group, the performance of general ophthalmologists in classifying 40 pairs of serial optic disc photos for change improved after a short training session.
“We saw that training matters, and we put online a free course for the appraisal of optic disc photos. You simply type EGODAP in your search engine,” Zeyen said.
In his clinic, he takes routine optic disc stereo photos with a non-mydriatic fundus camera.
“We look at the classic features, such as rim loss, pallor, nerve fiber layer defect, but also at optic disc hemorrhages that often precede rim loss of a couple of months and are a red flag to modify your treatment. Vessel positioning change is another sign that you can see only in serial photos,” he said.
He recommended taking at least one photo at baseline to compare with ophthalmoscopy or other photos at further stages. No expensive equipment is needed.
“You can buy, for less than 400, smartphone-based technology such as a slit lamp adapter or an optical adapter and take excellent quality, monoscopic, non-mydriatic fundus photos,” he said. – by Michela Cimberle
Reference:
Zeyen T. Can imaging substitute ophthalmoscopy and optic disc photos in the diagnosis and follow up? Presented at: European Glaucoma Society Congress; June 19-22, 2016; Prague.
Disclosure: Zeyen reports no relevant financial disclosures.