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Pathology revealed in ‘asymptomatic’ patient

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Figure 1. Optomap ultra-widefield digital retinal imaging reveals retinal detachment

______________________________

Ray Fortescue
BOptom(Hons) FCLSA

Product
optomap P200C Ultra-widefield Digital Retinal Imaging System

Supplier
Optos

 

EyeQ Optometrists has more than 20 practices across the nation. Some of our practices are adding an optomap Ultra-widefield Digital Retinal Imaging System to the extensive list of diagnostic equipment already available.

The EyeQ business model supports the ideals of full-scope independent optometry by providing all the ‘back end’ systems required to drive the business and to allow expert eye care to flourish. With this philosophy, it was clear that EyeQ needed to embrace the latest technology.

Using the optomap has now become an almost standard offer to every patient, from toddlers to centenarians. Ancillary support staff will most often perform the scan in a dedicated room; the results are then reviewed in the consulting room with the optometrist. The optomap panoramic image is one of the reasons behind our regular detection of ‘unexpected’ lesions.

CASE REPORT

A 63-year-old man presented for a routine check-up. He was pseudophakic, having had bilateral cataract surgery and monofocal IOL implantation in 2007. His prescription pre-surgery was R -5.50 L -5.25/-0.75 x 180.

On presentation, he was asymptomatic. Having been prescribed monovision intraocular lenses, his prescription was R +0.50/-0.50 x 150 (6/6+) L -2.50/-0.75 x 165 (6/6). He coped well unaided. Intraocular pressures were R 18.5 mmHg L 19 mmHg using Goldmann applanation tonometry.

Routine optomap ultra-widefield digital retinal imaging revealed a sectorial superior retinal detachment (macula on) in the left eye (Figure 1). The lesion was flat. Under dilation, the area in question was subtly detached, although this was not particularly obvious using slitlamp fundoscopy and BIO with a 20 D lens.

Humphrey Visual Field Analyzer test confirmed a corresponding reduction in sensitivity in the inferior visual field as close as 10 degrees from the visual axis (Figures 2 and 3). The patient was unaware of any visual impediments.

 

EQ 190 Figure 2 Right visual field - online.jpg

Figure 2. Right visual field

 

EQ 190 Figure 3 Left visual field - online.jpg

Figure 3. Left visual field

 

He was referred urgently to Sydney Eye Hospital where he underwent retinal detachment surgery the next day with good results expected.

The lesson learned from this experience is that even during a typical ‘asymptomatic’ presentation, a potentially disastrous vision outcome would have resulted if a routine optomap ultra-widefield scan had not been performed.



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