Walk into any ophthalmic consulting room today and you’re likely to find an Aladdin’s cave of high-tech ophthalmic instruments capable of delving into the eye’s structures to assess eye health and underlying health conditions.
Catharine Chisholm, former president of the British Contact Lens Association and clinical affairs manager for Topcon Medical GB, explains: “We are moving into a new age in eye healthcare where advances in imaging technology are enabling opticians to spend less time taking measurements, and more time analysing the findings and providing patients with a tailored management plan.
“Instruments for measuring the pressure inside the eye or photographing the back of the eye, for example, are now so automated and user-friendly that other members of staff can be trained in their use, further freeing up valuable consultation time for the patient,” says Dr Chisholm.
One of the most important structures of the eye to be assessed during the eye test is the retina. Using a digital fundus camera, your optician can attain a snapshot of the interior surface of the eye, including the retina, optic disc, macula and posterior pole (the fundus).
The test requires the patient to sit at the fundus camera with their chin in a rest and forehead against a bar. The optician focuses and aligns the camera then a flash goes off as the shutter is pressed, and a fundus photograph created. The resulting retinal photographs can then be used to follow, diagnose and monitor eye diseases.
“It’s true that ‘a picture is worth a thousand words’ and digital retinal photography creates a library of images for the patient that can be compared and reviewed on successive visits,” says Amanda Danson, optometrist and clinical director at Birmingham Optical. Such technology forms the backbone of diabetic retinal screening services.
EARLY DETECTION
In addition to hospital eye departments, a growing number of optical practices now also offer the more sophisticated imaging technology of optical coherence tomography (OCT). “This enables the retina to be reviewed in extraordinary detail – to not only see what is on the surface but, more importantly, to see any changes in the layers beneath where many conditions can be detected at an earlier stage,” says Ms Danson.
We are moving into a new age in eye healthcare where advances in imaging technology are enabling opticians to provide patients with a tailored management plan
Most commonly used by ophthalmologists, OCT is a rapid, non-invasive imaging test that uses light waves to take cross-sectional, 3D images of the retina. With OCT, each of the retina’s distinctive layers can be seen, allowing the clinician to map and measure their thickness. These measurements help with the early detection, diagnosis and treatment of retinal diseases and conditions, including macular degeneration, macular oedema and diabetic eye disease.
OCT is also often used to evaluate disorders of the optic nerve. The optic nerve is made up of many nerve fibres and sends signals from your retina to your brain, where these signals are interpreted as the images you see. The OCT exam is helpful in determining changes to optic nerve fibres, such as those caused by glaucoma.
An additional benefit of OCT is that it allows some patients to visit their local optometrist for in-depth analysis rather than travelling to hospital. “Some optometrists are sharing retinal images or scans with hospital ophthalmologists if they are uncertain about whether to refer, thus increasing patient access to expert knowledge without the patient necessarily having to travel to the hospital,” adds Dr Chisholm.
THROUGH A CONTACT LENS
But it’s not just developments in ophthalmic imaging that are leading to better eye healthcare. Advances in contact lens technology have improved both comfort and vision, with lenses to correct distance and near-vision now widely available, meeting the needs of our ageing population.
“When wearing contact lenses, there are no glasses frames ‘in the way’ – so all in all they offer a more convenient, restful and effortless way to see clearly,” says Mark Chatham, contact lens optician and clinical specialist at CooperVision. “And, of course, there is the great flexibility which comes from having a different look for different occasions.”
Big news in the contact lens world right now is the development of lenses that slow the development of short-sight (myopia) in children. “The advent of contact lenses to slow down the progression of myopia is likely to revolutionise children’s eyecare in the next few years,” Dr Chisholm predicts.
“Although myopia cannot be prevented, reducing its progression may have significant implications for the risk of eye disease later in life – something that will undoubtedly have an impact at a public health level too.”
Other potentially revolutionary developments on the horizon include anti-allergy contact lenses, and lenses capable of monitoring diabetes and glaucoma. Even Google is getting in on the act by working with pharmaceutical giant Novartis to develop a “smart” contact lens featuring non-invasive sensors, microchips and other miniaturised electronics to address ocular conditions.
Whatever comes next, developments in eyecare technology are already offering a world of possibilities to improve vision and eye health – many of them at the mere click of a shutter.
