International Conference on Ophthalmic Photography

Organized by
Australian Institute of Medical and Biological Illustration
Japanese Ophthalmic Photographers' Society
Ophthalmic Imaging Association
Ophthalmic Photographers' Society

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Sunday, 21 May 2006
Plenary Session 8
Imaging Technology and Applications III
1.50 OPS Continuing Education Credits
08:45 Introduction By Moderator
Marshall E. Tyler
Wake Forest University Medical Center
Winston-Salem, North Carolina, USA
08:50 Recent Developments Of Ultra-Wide-Field Fluorescein Angiography Using A Scanning Laser Ophthalmoscope: Prototype To Beta
Alison J Farrow, A Manivannan, John Forrester, Peter Sharp
University of Aberdeen, Aberdeen, Scotland, UK
Puropose: Ultra-wide field fluorescein angiography is particularly suited to conditions where the pathology of interest lies in the periphery. Until recently these images could be obtained using sequentially acquired quadrant images which were either viewed serially or assembled as a composite. A supplementary lens in front of a conventional fundus camera has also been used. This presentation will describe progress in obtaining one-shot ultra-widefield angiography images.
Materials and Methods: Images obtained previously with a prototype SLO were compared with images from the most recent pre-production version, distortion and resolution were examined. The various technical improvements include a redesigned mirror and software.
Results: Images from the different generations of the SLO camera were compared.
Conclusions: The advantage over conventional methods of acquiring peripheral images is the capture of wide-field retinal pathology in a digital format and up to a 200 degree field. Enhancements from the prototype include increased resolution, and removal of the mirror distortion which caused a ‘tilted disc’ appearance. Limitations include need for accuracy of patient alignment during angiography and artefacts such as lashes limiting the field of view.

09:05 Results Of Nd:YAG Laser Hyaloid / Retinotomy For Hemorrhagic Retinopathy
Edward V. Starunov, Andrey G. Shchuko¹, Vladimir V. Malyshev¹
Sv. Fedorov Eye Microsurgery Institute¹
Irkutsk, Irkutsk, Russia
Purpose: To develop methods of laser influence, to optimize terms and volume of intervention, to estimate treatment efficiency of macular hemorrhagic retinopathy.
Materials and Methods: Results of Nd:YAG laser hyaloid/retinotomy, performed in period from 2000 to 2005 in Irkutsk branch “Eye Microsurgery”, were analyzed. The main group consisted of 34 patients (34 eyes), 25 women and 9 men, in the age from 16 till 79 years. Clinical comparison group included 25 patients (in the age from 13 till 72 years) undergoing therapeutic treatment. Standard ophthalmic examination, fluorescein angiography, ERG, OCT and dynamic photo registration on a digital fundus camera were made.
Intervention was carried out with Peyman (25 mm) and Goldman contact lenses using, energy in a pulse 3 - 8 mJ/sm2, 2-3 points were made in macular hemorrhage zone. Increase of drainage effect was achieved by performance of the counter-aperture in a superior-outer segment. The compression of an eyeball was applied for the blood evacuation increase. Focal laser coagulation around Nd:YAG injuries for prevention retinal detachment was done 2-3 weeks after retinotomy.
Results: Visual acuity was increased within 4-10 weeks. The most successful results were noted at laser intervention in 3-4 days. In all cases the visual acuity elevation was noted. The elevation in the main group was greater than in the comparative group.
Conclusions: The follow-up results have shown the stability of visual functions and the absence of specific complications.

09:20 Back To the Future – A Visual Diagnostic History
Mark Maio
Ophthalmic Imaging Systems
Sacramento, California, USA
Purpose: To solve the problem of reviewing and comparing results from multiple diagnostic report modalities (HVF, OCT, etc.), on a given patient stored over time in an ophthalmic imaging database.
Materials and Methods: A software module was developed and added to an existing digital imaging software program which automatically assembles, collates and arranges all diagnostic report modalities acquired historically in chronological order. Priority was given to designing an easy to use interface while still providing maximum diagnostic information. Throughout the software development process, ophthalmologists, ophthalmic photographers and technicians were consulted.
Results: A graphic user interface was designed and added to the software which will automatically display retrieved diagnostic report modalities arranged by eye and date.
Conclusions: It is now possible to easily and automatically compare multiple modalities done over time and stored electronically, adding comparative visual information to the diagnostic process.

09:35 Getting The 'Bigger' Picture In Ophthalmic Imaging - Comparing Various Exam Results
Ethan R. Priel
MOR Institute
Bnei Brak, Israel
Purpose: To highlight the importance and benefits of reviewing and comparing results from several imaging and testing modalities as a way of enhancing our understanding of the pathologies seen in fluorescein angiography (FA).
Materials and Methods: Results obtained from color fundus photography, FA, ICG, OCT, ultrasound (US), visual fields (VF), and slit lamp photography (in the above order) were collated from the charts of patients referred to the Ophthalmic Diagnostic Center.
Special attention was paid to comparing findings from as identical as possible locations.
Photographers and ophthalmologists were asked to offer a diagnosis based on one or more type of result.
Results: In all cases reviewed, there was some additional information to be observed from the supplemental tests. In some cases, the additional results helped arrive at a diagnosis or even change one diagnosis to another.
Conclusions: Basing a diagnosis on one testing modality alone can be sufficient in many cases, but in some of the more challenging instances, additional test results help us arrive at a more in-depth understanding of the processes taking place in the retina and choroid.

09:50 The Usefulness Of Color In Fundus Imaging
Tom N. Cornsweet
Visual Pathways, Inc.
Prescott, Arizona, USA
Purpose: To examine the information observable in color fundus images, and in monochrome images collected using specific colors for illumination.
Materials and Methods: The physical nature of the interactions between tissues in the eye and lights of different wavelengths will be discussed. How these interactions generate images of fundus features and pathologies will be examined, briefly for film images and more extensively for digital images.
Results: Standard color film and standard color digital cameras produce fundus images whose physical characteristics are difficult to analyze. Further, films and digital cameras from different manufacturers can produce differing images of the same subject. That is, different films can produce different images and images from different digital cameras can vary among themselves. Further, standard color film and color digital cameras are not designed to optimize the information in a fundus image that is useful for the physician. It is possible, however, to correct those problems.
Conclusions: Using carefully selected color filters, fundus images can be obtained that provide significantly more useful information than that provided by standard cameras or film. Examples will be displayed.

10:05 Accurate Stereo Fundus Imaging
Tom N. Cornsweet
Visual Pathways, Inc.
Prescott, Arizona, USA
Purpose: To develop an understanding of the factors involved in acquiring reliable and accurate stereo images.
Materials and Methods: The geometry of collecting and viewing stereo images will be presented. Factors that cause variations in their apparent depth will be discussed, and methods for minimizing those factors will be presented.
Results: Eye movements of the patient rarely affect the accuracy of the depth apparent in a stereo image pair, but do cause difficulties in viewing the pair. Head movements, changes in pupil size, and inconsistent camera movement by the photographer, if uncompensated, cause serious variations in the apparent depth of stereo images. This variation, in turn, greatly reduces the usefulness of stereo images when used to evaluate progression of pathology over time.
Conclusions: Using the appropriate software, eye movements can be compensated, to make stereo viewing effortless, and the variations due to head movements, pupil size, and photographer inconsistency can eliminated, greatly increasing the usefulness of stereo imaging. A demonstration will be available.

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Sunday, 21 May 2006 Plenary Session 8 Imaging Technology and Applications III 1.50 OPS Continuing Education Credits
08:45	Introduction By Moderator Marshall E. Tyler Wake Forest University Medical Center Winston-Salem, North Carolina, USA
08:50	Recent Developments Of Ultra-Wide-Field Fluorescein Angiography Using A Scanning Laser Ophthalmoscope: Prototype To Beta Alison J Farrow, A Manivannan, John Forrester, Peter Sharp University of Aberdeen, Aberdeen, Scotland, UK Puropose: Ultra-wide field fluorescein angiography is particularly suited to conditions where the pathology of interest lies in the periphery. Until recently these images could be obtained using sequentially acquired quadrant images which were either viewed serially or assembled as a composite. A supplementary lens in front of a conventional fundus camera has also been used. This presentation will describe progress in obtaining one-shot ultra-widefield angiography images. Materials and Methods: Images obtained previously with a prototype SLO were compared with images from the most recent pre-production version, distortion and resolution were examined. The various technical improvements include a redesigned mirror and software. Results: Images from the different generations of the SLO camera were compared. Conclusions: The advantage over conventional methods of acquiring peripheral images is the capture of wide-field retinal pathology in a digital format and up to a 200 degree field. Enhancements from the prototype include increased resolution, and removal of the mirror distortion which caused a ‘tilted disc’ appearance. Limitations include need for accuracy of patient alignment during angiography and artefacts such as lashes limiting the field of view.
09:05	Results Of Nd:YAG Laser Hyaloid / Retinotomy For Hemorrhagic Retinopathy Edward V. Starunov, Andrey G. Shchuko¹, Vladimir V. Malyshev¹ Sv. Fedorov Eye Microsurgery Institute¹ Irkutsk, Irkutsk, Russia Purpose: To develop methods of laser influence, to optimize terms and volume of intervention, to estimate treatment efficiency of macular hemorrhagic retinopathy. Materials and Methods: Results of Nd:YAG laser hyaloid/retinotomy, performed in period from 2000 to 2005 in Irkutsk branch “Eye Microsurgery”, were analyzed. The main group consisted of 34 patients (34 eyes), 25 women and 9 men, in the age from 16 till 79 years. Clinical comparison group included 25 patients (in the age from 13 till 72 years) undergoing therapeutic treatment. Standard ophthalmic examination, fluorescein angiography, ERG, OCT and dynamic photo registration on a digital fundus camera were made. Intervention was carried out with Peyman (25 mm) and Goldman contact lenses using, energy in a pulse 3 - 8 mJ/sm2, 2-3 points were made in macular hemorrhage zone. Increase of drainage effect was achieved by performance of the counter-aperture in a superior-outer segment. The compression of an eyeball was applied for the blood evacuation increase. Focal laser coagulation around Nd:YAG injuries for prevention retinal detachment was done 2-3 weeks after retinotomy. Results: Visual acuity was increased within 4-10 weeks. The most successful results were noted at laser intervention in 3-4 days. In all cases the visual acuity elevation was noted. The elevation in the main group was greater than in the comparative group. Conclusions: The follow-up results have shown the stability of visual functions and the absence of specific complications.
09:20	Back To the Future – A Visual Diagnostic History Mark Maio Ophthalmic Imaging Systems Sacramento, California, USA Purpose: To solve the problem of reviewing and comparing results from multiple diagnostic report modalities (HVF, OCT, etc.), on a given patient stored over time in an ophthalmic imaging database. Materials and Methods: A software module was developed and added to an existing digital imaging software program which automatically assembles, collates and arranges all diagnostic report modalities acquired historically in chronological order. Priority was given to designing an easy to use interface while still providing maximum diagnostic information. Throughout the software development process, ophthalmologists, ophthalmic photographers and technicians were consulted. Results: A graphic user interface was designed and added to the software which will automatically display retrieved diagnostic report modalities arranged by eye and date. Conclusions: It is now possible to easily and automatically compare multiple modalities done over time and stored electronically, adding comparative visual information to the diagnostic process.
09:35	Getting The 'Bigger' Picture In Ophthalmic Imaging - Comparing Various Exam Results Ethan R. Priel MOR Institute Bnei Brak, Israel Purpose: To highlight the importance and benefits of reviewing and comparing results from several imaging and testing modalities as a way of enhancing our understanding of the pathologies seen in fluorescein angiography (FA). Materials and Methods: Results obtained from color fundus photography, FA, ICG, OCT, ultrasound (US), visual fields (VF), and slit lamp photography (in the above order) were collated from the charts of patients referred to the Ophthalmic Diagnostic Center. Special attention was paid to comparing findings from as identical as possible locations. Photographers and ophthalmologists were asked to offer a diagnosis based on one or more type of result. Results: In all cases reviewed, there was some additional information to be observed from the supplemental tests. In some cases, the additional results helped arrive at a diagnosis or even change one diagnosis to another. Conclusions: Basing a diagnosis on one testing modality alone can be sufficient in many cases, but in some of the more challenging instances, additional test results help us arrive at a more in-depth understanding of the processes taking place in the retina and choroid.
09:50	The Usefulness Of Color In Fundus Imaging Tom N. Cornsweet Visual Pathways, Inc. Prescott, Arizona, USA Purpose: To examine the information observable in color fundus images, and in monochrome images collected using specific colors for illumination. Materials and Methods: The physical nature of the interactions between tissues in the eye and lights of different wavelengths will be discussed. How these interactions generate images of fundus features and pathologies will be examined, briefly for film images and more extensively for digital images. Results: Standard color film and standard color digital cameras produce fundus images whose physical characteristics are difficult to analyze. Further, films and digital cameras from different manufacturers can produce differing images of the same subject. That is, different films can produce different images and images from different digital cameras can vary among themselves. Further, standard color film and color digital cameras are not designed to optimize the information in a fundus image that is useful for the physician. It is possible, however, to correct those problems. Conclusions: Using carefully selected color filters, fundus images can be obtained that provide significantly more useful information than that provided by standard cameras or film. Examples will be displayed.
10:05	Accurate Stereo Fundus Imaging Tom N. Cornsweet Visual Pathways, Inc. Prescott, Arizona, USA Purpose: To develop an understanding of the factors involved in acquiring reliable and accurate stereo images. Materials and Methods: The geometry of collecting and viewing stereo images will be presented. Factors that cause variations in their apparent depth will be discussed, and methods for minimizing those factors will be presented. Results: Eye movements of the patient rarely affect the accuracy of the depth apparent in a stereo image pair, but do cause difficulties in viewing the pair. Head movements, changes in pupil size, and inconsistent camera movement by the photographer, if uncompensated, cause serious variations in the apparent depth of stereo images. This variation, in turn, greatly reduces the usefulness of stereo images when used to evaluate progression of pathology over time. Conclusions: Using the appropriate software, eye movements can be compensated, to make stereo viewing effortless, and the variations due to head movements, pupil size, and photographer inconsistency can eliminated, greatly increasing the usefulness of stereo imaging. A demonstration will be available.