I T S . T I M E . T O . P L A Y
NAME THAT PATHOLOGY

HOW WOULD YOU CLASSIFY THE FIERY LOOKING REGION
(SUPERIOR TEMPORAL TO THE OPTIC DISC) IN THE RETINA ABOVE?
(a) A NEVUS
(b) A BENIGN NEOPLASM
(c) A MELANOMA
(d) A CARCINOMA

THE ANGIOGRAPHY SHOWS ONLY A TRANSMISSIONAL FLUORESCENCE OF THAT AREA OF
THE RETINA WHICH IS INDICATIVE OF A
(b) BENIGN (CHOROIDAL) NEOPLASM.

PHOTO MONTAGE II:
S C I E N C E . A S . A R T ?
HERE ARE A COUPLE MORE OPHTHALMIC PHOTO MONTAGES WITH A TWIST;
IN BOTH, MERGED A COLOR, FUNDUS PHOTO WITH A RED-FREE, BLACK AND WHITE PHOTO AND A MID-VENOUS PHASE ANGIOGRAM. ALTHOUGH THERE IS PROBABLY NO CLINICAL APPLICATION FOR THESE HYBRID IMAGES,
IT IS SORT OF COOL LOOKING.
GLAUCOMA

DIABETIC RETINOPATHY

PHOTO MONTAGE I
DIGITAL CAPTURE IN FUNDUS PHOTOGRAPHY AND ANGIOGRAPHY
HAS ALLOWED FOR UNIQUE AND INTERESTING WAYS OF RETINAL
IMAGING. BELOW IS A COLOR PHOTO OF A PATIENT WHO
IS SUFFERING FROM DIABETIC RETINOPATHY AND IS PRESENTING
WITH A 'BOAT-SHAPED' PRE-RETINAL HEMORRHAGE.

HERE ARE SEVERAL DIFFERENT VIEWS OF THE SAME RETINA
TAKEN DURING THE ANGIOGRAM.THE SOFTWARE ASSOCIATED WITH OUR DIGITAL CAPTURE SYSTEM CAN 'STITCH' (OR MONTAGE) THESE IMAGES TOGETHER TO GIVE US A BETTER, OVERALL VIEW OF THE RETINA. NOW WE CAN VIEW THE HEMORRHAGE AS WELL AS THE AREA OF NVE (NEO-VASCULARIZATION ELSEWHERE) IN THE SUPERIOR TEMPORAL REGION OF THE RETINA THAT IS LIKELY RESPONSIBLE FOR THAT HEMORRHAGE. WE CAN ALSO SEE THE EXTENT OF PAN-RETINAL LASER TREATMENT THIS PATIENT HAS HAD IN THE PAST (THE SMALL DARK SPLOTCHY SPOTS).

MORE ANGIOGRAPHY
HERE'S A BIT MORE ABOUT THE PROCESS OF OBTAINING A GOOD ANGIOGRAM.
WE WOULD START BY GETTING A SHARP, WELL EXPOSED COLOR IMAGE OF THE RETINA. BELOW IS A FUNDUS PHOTOGRAPH OF A DIABETIC PATIENT'S LEFT EYE.

THE FUNDUS PHOTO IS USED AS A 'BASE-LINE' IMAGE. IN SOME CASES , A RED-FREE PHOTOGRAPH
IS ALSO USED AS A 'BASE-LINE'. THE FIRST IMAGE IN THE ANGIOGRAM BELOW (TOP RIGHT NUMBERED '7')
IS A RED-FREE PHOTO. NEXT, APPROXIMATELY 5 CC OF SODIUM FLUORESCEIN ARE INJECTED
INTO THE PATIENT'S BLOODSTREAM. FLUORESCEIN IS A MINERAL DYE THAT FLUORESCES UNDER A BLUE
LIGHT (APPROXIMATELY 490 NM). IT TAKES ABOUT 10-20 SECONDS FOR THE DYE TO REACH THE RETINA.
AT THIS POINT, PHOTOS NEED TO BE TAKEN AT A RATE OF ABOUT 1 PER SECOND TO GIVE AN ACCURATE
ACCOUNT OF THE PATIENT'S RETINAL CIRCULATION. BELOW WE CAN TRACE THE DYE THROUGH
THE RETINAL ARTERIAL STAGE (TOP ROW IMAGES # '9','10', AND '11')
THE EARLY VENOUS STAGE (SECOND ROW IMAGES # '12', '13', '14', AND '15')
VENOUS AND LATE VENOUS STAGES (IMAGES # '17', '19', '22', '25', '27', '30', AND '31')
AND FINALLY
THE LATE STAINING OCCURRING ABOUT 5 MINUTES AFTER THE INJECTION (IMAGE #'39').
THE RETINAL IMAGES IN THE ANGIOGRAM 'READ' FROM RIGHT TO LEFT AND THEIR TIMES ARE DISPLAYED IN THE UPPER LEFT OF EACH IMAGE. THE TIMES REFER TO THE POINT THE IMAGE WAS CAPTURED FOLLOWING THE INJECTION.

A. I. O. N.
ANTERIOR ISCHEMIC OPTIC NEUROPATHY
IS A CONDITION CAUSED BY THE INFARCTION OF BLOOD VESSELS THAT WOULD OTHERWISE SUPPLY THE ANTERIOR (OR FRONT) OF THE OPTIC NERVE. PATIENTS WITH AION WILL (INEVITABLY) PRESENT WITH A PALE, SWOLLEN OPTIC DISC AS WELL AS ASSOCIATED HEMORRAGING WHICH CAN BE NOTED IN THE COLOR FUNDUS PHOTO BELOW.

THE ANGIOGRAPHY ABOVE SHOWS THE VENOUS STAGE OCCURRING QUITE LATE IN THE ANGIOGRAM (ALMOST A MINUTE), WHICH IS TYPICAL IN AION PATIENTS AS THEIR CIRCULATION IS SUB-STANDARD.

ENOUGH PATHOLOGY, TIME FOR SOME:

A N A T O M YTHE OPTIC DISC IS THE POINT WHERE THE OPTIC NERVE ENTERS THE RETINA
THE MACULA IS THE PIGMENTED AREA OF THE RETINA THAT IS RICH IN CONES
AND IS RESPONSIBLE FOR CLEAR DETAILED VISION
THE FOVEA IS A SMALL RODLESS AREA OF THE MACULA THAT PROVIDES ACUTE VISION