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).

S C A N S III - M A C U L A R H O L E
BELOW ARE TWO OCT SCANS OF A MACULAR HOLE.
A MACULAR HOLE IS TYPICALLY CAUSED BY A PATHOLOGICAL THINNING OR SHRINKING OF THE VITREOUS WITHIN THE EYE. VITREOUS IS THE JELLY-LIKE SUBSTANCE THAT FILLS THE EYE AND IS ATTACHED TO THE RETINA. AS THE VITREOUS 'SHRINKS' IT PULLS AT THE RETINA AND THE MACULA. THIS TRACTION CAUSES THE MACULAR HOLE AND THE OVERALL RESULT IS DISTORTION IN OR COMPLETE LOSS OF FINE DETAILED VISION.

THE TREATMENT FOR THIS CONDITION IS A SURGICAL PROCEDURE KNOWN AS A VITRECTOMY. BASICALLY, THE VITREOUS IS REMOVED FROM THE EYE AND REPLACED WTIH A SALINE SOLUTION. THEN A TINY BIT OF THE REMAINING MACULAR TISSUE IS 'PEELED' TO PROMPT HEALING IN THAT AREA. FINALLY, THE EYE IS FILLED WITH A GAS BUBBLE THAT HOLDS THE TISSUE IN PLACE UNTIL IT IS COMPLETELY HEALED. THE GAS BUBBLE EVENTUALLY DISSIPATES AND THE EYE REFILLS WITH ITS OWN FLUID ONCE MORE. POST OPERATION RECOVERY CAN BE VERY CHALLENGING, HOWEVER, AS THE PATIENT WILL NEED TO POSITION THEIR HEAD 'FACE-DOWN' CONTINUOUSLY FOR SEVERAL DAYS FOLLOWING THE SURGERY.

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.

SLITLAMP PHOTOGRAPHY I:

A SLITLAMP IS A HIGH INTENSITY LIGHT SOURCE CONCENTRATED INTO A NARROW

BEAM (OR SLIT) OF LIGHT USED IN CONCERT WITH A MICROSCOPE TO EXAMINE
THE ANTERIOR SEGMENT ( FRONT) OF THE EYE. INCORPORATE AN IMAGE

CAPTURING DEVICE AND NOW YOU HAVE A SLITLAMP CAMERA.
HERE IS ONE OF MY FIRST SLITLAMP PHOTOS.

THIS PATIENT WAS REFERRED TO PHOTOGRAPHY TO GET IMAGES OF HIS pterygium.
HOWEVER, HE COULD ACTUALLY BE SUFFERING FROM A CORNEAL INTRAEPITHELIAL NEOPLASM

SRNVM REDUX: RETURN OF THE PANDA
THIS IS A FOLLOW-UP ANGIOGRAM OF ONE OF MY EARLIER PATIENTS. UNFORTUNATELY, WITH A SUBRETINAL NEOVASCULAR MEMBRANE THERE IS LITTLE CHANCE OF IMPROVING THE CONDITION. IN A CASE SUCH AS THIS, A RETINAL MD'S AIM IS TO PREVENT ANY PROGRESSION OF THE DISEASE.

AFTER TAKING THIS PICTURE, I TOLD THIS PATIENT THAT I THOUGHT HER CONDITION RESEMBLED A PANDA BEAR. INITIALLY, SHE SEEMED A BIT "PUT-OFF" BY MY COMMENT; BUT AFTER OUR SESSION, SHE WANTED A COPY OF THE ANGIOGRAM TO SHOW FAMILY AND FRIENDS. SHE IS really WONDERFUL TO WORK WITH.

SCANS - II
O P T I C A L . C O H E R E N C E . T O M O G R A P H Y
PROVIDES ANOTHER WAY OF "LOOKING" AT THE RETINA. THE STRATUS OCT SENDS BEAMS OF LIGHT INTO OUR PATIENTS' EYES AND THEN READS THE REFLECTIONS SENT BACK FROM THE DIFFERENT LAYERS OF THE RETINA. IT THEN INTERPRETS THOSE REFLECTIONS AND CREATES A VIRTUAL CROSS-SECTION OF THE RETINA. BELOW ARE TWO SCANS OF THE SAME EYE. THE FIRST IS A HORIZONTAL SCAN OF THE MACULA AND THE SECOND IS A VERTICAL SCAN. BOTH SCANS SHOW A 'PUCKERING' OF THE MACULA DUE TO CELLOPHANE RETINOPAHTY. WE WOULD NOT BE ABLE TO TELL THE TRUE EXTENT OF THIS CONDITION WITH A TYPICAL FUNDUS PHOTO.

HORTIZONAL

VERTICAL

WE TYPICALLY PERFORM SCANS OF EITHER THE MACULA OR THE NERVE FIBER LAYER AROUND THE OPTIC DISC. I HOPE TO SHOW OTHER PATHOLOGIES I AM SEEING WITH THE OCT SCANS IN FUTURE POSTS.

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.