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PubMed1996

Screening for diabetic retinopathy in South Africa with 60 degrees retinal colour photography.

OBJECTIVES: Comparison of 60 degrees mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45 degrees fields. DESIGN: Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45 degrees fields (by masking the slides), and at 60 degrees. SETTING: The first 663 patients attending for routine clinic visits and screened for retinopathy. MAIN OUTCOME MEASURES: The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening. RESULTS: Compared to an ophthalmologist's assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60 degrees field, one 45 degrees field missed 31%, and 2 x 45 degrees fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US $37.00. CONCLUSIONS: 60 degrees retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45 degrees field assessments. Both retinae should be screened. This method is cost-effective in our hands.

Diabetic Retinopathy↗

PubMed2004

[Bifocal photography using the HRA -- an optimized method to evaluate tIOL's axial orientation].

BACKGROUND: The assessment of axial orientation of toric IOLs (tIOLs) by monofocal photography can be deteriorated due to intrinsic errors e. g. globe rotation, head inclination or inadequate camera adaption and slide projection. METHOD: In a 67 years old female a tIOL was implanted after penetrating keratoplasty for correction of high corneal astigmatism. A sequence of two fundus and two tIOL photographs (bifocal photography) was taken in a time interval of 3 months using the HRA II (Heidelberg Retina Angiograph II). A reference at the fundus was defined using two characteristic markers. The axial fundus orientation between the markers was overlaid to the line defined by the tIOL axis markers. The angular offset/distance between the fundus orientation line and the tIOL marker line was analyzed for each bifocal image at different time points. RESULTS: The comparison of axial tIOL orientation between both different tIOL images revealed a rotation angle of 13 degrees (monofocal photograph). In contrast, using the bifocal photography and digital overlay technique the fundus line as a reference the tIOL rotated 1 degrees and 4 degrees from the first to the second time point of photography. Thus, the real rotation angle of tIOL measured only 3 degrees. CONCLUSION: The bifocal photography with constant head position has the potential to minimize the intrinsic error in documentation of axial orientation of tIOL.

Aged↗

PubMed1999

Combined system of biomicroscopic vitreous videography and photography.

PURPOSE: To combine the techniques of biomicroscopic vitreous videography and vitreous photography when examining patients with age- or disease-related vitreous changes. METHODS: We performed biomicroscopic vitreous videography and photography using the newly developed digital photo camera (one-half-inch three-charged coupled device camera with high resolution of 800 x 800 television lines) connected to a slit-lamp biomicroscope and compared it with conventional 35-mm slit-lamp photography in 24 consecutive eyes of 19 patients with idiopathic macular breaks. RESULTS: Stage 1 macular breaks were found in three eyes, stage 2 in four eyes, stage 3 in 11 eyes, and stage 4 in six eyes. Both vitreous videographs and still photographs were recorded and reviewed rapidly in one system. Using this system, dynamic vitreous changes and still vitreous images were documented clearly with real-time television monitoring without using flash illumination. The still images obtained from this system were better than those obtained using conventional 35-mm slit-lamp photography in cases with stage 1, 2, and 3 macular breaks (P = 0.0000000001 by Fisher's exact test). CONCLUSION: This combined system of biomicroscopic vitreous videography and photography may become the standard system of biomicroscopic vitreous examination.

Aged↗

PubMedDate not supplied

An approach to emergency department photography.

In the emergency department, photography requires an expedient, portable, adaptable, and relatively simple camera system to take advantage of fleeting opportunities for recording visually educational material. These prerequisites are different from those for traditional medical photography, for which relatively plentiful time and advanced equipment are routinely available. Medical photography departments provide an invaluable service, but are rarely convenient for immediate or spontaneous emergency department photographs. Although no single system or technique is optimal in all these areas, the authors find certain components and approaches work well. They review photographic equipment, paying attention to speed, ease of use, and quality of output. They also review simple techniques such as film choice, lighting, close-up photography, standardization, copy work, and radiographs. Attention to these details can help the inexperienced photographer obtain a system and begin to enjoy the rewards of effective photography in the emergency department.

Emergency Medicine↗

PubMed1995

Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study.

OBJECTIVE: To evaluate different methods for community based screening for sight threatening diabetic eye disease. DESIGN: Prospective study. SETTING: Mobile screening unit visiting inner city community clinics; hospital assessment clinic (tertiary centre). SUBJECTS: 395 diabetic patients registered with four general practices in an inner city location. INTERVENTIONS: Community based photography with mydriasis and direct ophthalmoscopy through dilated pupils by an experienced ophthalmologist, both compared with reference standard of slit lamp biomicroscopy by a consultant specialist in medical retinal disease. MAIN OUTCOME MEASURES: Sensitivity and specificity of screening method and prevalence of sight threatening diabetic eye disease (moderate preproliferative retinopathy, circinate maculopathy, exudate within 1 disc diameter of fixation, other diabetes related eye disease). RESULTS: 358 subjects underwent photography, 326 attended hospital clinic for ophthalmoscopy, and six were ungradable on photographs and biomicroscopy, leaving 320 for analysis. Of these 295 (91%) attended clinic within four months of photography. Sensitivity of detection of eye disease by photography was 89% (95% confidence interval 80% to 98%), significantly better than for direct ophthalmoscopy (65% (51% to 79%)). Analysis of patients with false negative results indicated possible improvement of photographic sensitivity to 93% by addition of stereoscopic macular pair photographs. Specificity of detection of sight threatening eye disease was 86% (82% to 90%) for photography and 97% (95% to 99%) for direct ophthalmoscopy. CONCLUSIONS: Since high sensitivity is essential for an effective screening programme, a photographic method should be considered as preferred option in national, community based screening programmes. Even in the hands of an experienced ophthalmologist, direct ophthalmoscopy is limited by weaknesses inherent to the instrument.

Ambulatory Care↗

PubMed1997

Screening for diabetic retinopathy in primary care: retinal photography alone can be used efficiently and effectively to exclude those with sight threatening lesions.

BACKGROUND: Good screening performance of retinal photography and ophthalmoscopy together in screening for diabetic retinopathy in primary care have been reported. This study reanalysed the data to evaluate the screening performance of photography alone. METHODS: One thousand and ten patients screened by fundal photography and ophthalmoscopy were studied retrospectively. Fundal photographs were quality graded with poor quality pictures being excluded from the analysis. Each patient was reviewed initially by both retinal photographs and ophthalmoscopy by an ophthalmologist, the "gold standard". Six months later the fundal photographs were reviewed and reported in a blinded manner by the ophthalmologist. RESULTS: Two thousand and fourteen photographs were obtained, of which 162 (8%) had to be excluded because of poor quality. On review of the remaining 1852 photographs in isolation, of 77 cases of severe retinopathy as determined by the "gold standard", 67 had severe changes on photography--detection rate 87%. Of the 1775 cases without sight threatening retinopathy only five were judged to have sight threatening changes on photography--false positive rate 0.3%. Considering sight threatening and background retinopathy together, the detection rate was 69% (257 of 375) and the false positive rate 1.6% (23 of 1477). CONCLUSION: Good quality fundal photographs alone seem specific enough to screen for sight threatening diabetic retinopathy, but will underdetect background retinopathy.

Diabetic Retinopathy↗

PubMed2005

Important clinical uses for digital photography.

Digital photography almost has overtaken the conventional photographic film industry. Most professional photographers are using either digital photography alone or a combination of digital and conventional film photography. The trend toward digital photography is not likely to change. Using digital photography in the dental office is fast, easy and highly useful for documenting treatment, carrying out patient education and accomplishing clinical research. Supervision and use of this new technology can be delegated to staff members, and it will provide many benefits to dentists and patients.

Delegation, Professional↗

PubMed2003

Automation of gross photography using a remote-controlled digital camera system.

CONTEXT: Conventional gross photography requires a series of tedious and time-consuming steps, including taking, developing, labeling, sorting, filing, and tracking numerous photographs. OBJECTIVE: To describe how to automate the gross photographic process by way of controlling a digital camera remotely. DESIGN: After defining the requirements of automation regarding gross photography, a remote control board, foot switch, barcode system, and image retrieval system were devised. SETTING: The surgical pathology laboratory of a university medical center with a commercially available megapixel digital camera. RESULTS: The digital camera zoom and shutter were controlled remotely by a foot switch. A large portion of the gross photographic process, including specimen number labeling, image downloading, labeling, sorting, filing, and tracking, were automated. In addition, the elimination of several manual specimen-processing steps, along with not having to wait for the developing and mounting of conventional 35-mm film, reduced the entire time span required in conventional gross photography from 2 to 5 days, to a few minutes. It was also possible to review the gross images at the time of microscopic sign-out. CONCLUSIONS: The automation of gross photography using a remote-controlled digital camera changes the conventional gross workflow markedly. We found use of a remote-controlled gross photography system to be practical, convenient, and efficient.

Cost-Benefit Analysis↗

PubMed2003

Ophthalmic photography using a digital camera.

PURPOSE: To report the application of a digital camera for ophthalmic photography in routine clinical use. METHODS: A digital camera (Nikon Coolpix 995) was used both for external macrophotography of the eye and ocular adnexa, and slitlamp photography of the anterior segment of the eye. RESULTS: We were able to take external macrophotographs under high magnification of the eye and ocular adnexa. Slitlamp photography could be performed under diffuse, slit beam, and retroillumination. The structures of the angle, the optic disc and surrounding retina could be photographed using appropriate lenses. The attachment to the operating microscope allowed intraoperative photography. It could also be attached to the laboratory microscope to capture images of various histopathology and microbiology slides. CONCLUSIONS: A digital camera is a versatile instrument for ophthalmic photography. It is easy to use in routine clinical practice and provides good quality photographs.

Eye↗

PubMed1985

Standardization in dental photography.

The main purpose of dental photography is documentation. This means that a maximum of information has to be recorded by photographic means under reproducible conditions. Only if the conditions are reproducible can photographs be regarded as really adequate recording tools. There must be standardization of the clinical camera and associated equipment, and the formating and lighting of those intra- and extra-oral views which are often used in dental photography. The most versatile camera body for dental photography is the 35 mm single-lens-reflex-camera. The proper lens is a 100 up to 135 mm-macrolens, which allows a magnification of 1:1 or better. The proper light source is a rotating side mounted flash unit or better, a twin flash with reflectors, each of them mounted at one side of the lens. Ring flash can be used in intra-oral photography. Five important views are described which portray the intra-oral status: a frontal view, two lateral views and occlusal views of the two arches. In addition to these views there are six facial views which are often used in dental practice: two lateral views; a frontal view; a frontal view with the head tilted back; and two fronto-lateral views at angles of 45 degrees to the sagittal plane. By standardizing the photographic conditions the photographs produced will be comparable to each other, even if successive photographs are taken at long time intervals and by different photographers. Only in this way can dental photography be used as a valuable aid to documentation.

Dentistry↗

PubMed1999

The role of digital fundus photography in diabetic retinopathy screening. Digital Diabetic Screening Group (DDSG).

PURPOSE: The role of digital monochromatic nonmydriatic fundus photography as an adjunct in the diagnosis of diabetic retinopathy is evaluated. METHODS: 197 patients were sequentially evaluated by three different techniques: dilated ophthalmoscopy by an experienced ophthalmologist, performance of 7 standard color mydriatic stereo fields, and a single digital monochromatic nonmydriatic image incorporating the disc and macula. Stereo color photographs served as the reference standard and were compared to either ophthalmoscopy performed by a physician, or a single digital photograph transmitted electronically to a reading site and evaluated by a trained non-physician grader. Sensitivity and specificity of the three methods were compared. The decision as to whether or not to refer to an ophthalmologist for potential treatment (Kaiser modified ETDRS level > 21) was then chosen for analysis. RESULTS: A single nonmydriatic monochromatic digital photograph appeared equivalent to standard color photography and more sensitive than mydriatic ophthalmoscopy in the detection of diabetic retinopathy in this patient population. Sensitivity of digital photography compared with color photography was 78%, and the specificity 86% contrasted with comparable ratios of 34% and 100% for ophthalmoscopy versus color photography. No patient identified by ophthalmoscopy alone for referral based on retinopathy level of > 21 would have been missed by a single digital monochromatic photographic image. CONCLUSION: A single nonmydriatic monochromatic wide field digital photograph of the disc and macula in diabetic patients is a sensitive and cost-effective means for detecting diabetic retinopathy in high-risk populations.

Allied Health Personnel↗

PubMedDate not supplied

Cost considerations of converting to digital photography.

OBJECTIVES: To provide the practicing surgeon with data to make an informed economic decision regarding conversion from analog to digital photography. METHODS: A cost analysis of photography based on 35-mm vs digital platforms (low-, medium-, and high-cost hardware). RESULTS: Break-even thresholds for the investment in a digital platform of low, medium, and high costs were 3674, 15,789, and 34,000 images, respectively. CONCLUSION: Given the current excellent image quality and ongoing refinements in digital photography, a digital photography platform may be cost-effective for a busy facial plastic surgery practice.

Analog-Digital Conversion↗

PubMed2004

Comparison of scanning laser polarimetry using variable corneal compensation and retinal nerve fiber layer photography for detection of glaucoma.

OBJECTIVE: To compare retinal nerve fiber layer (RNFL) measurements obtained with scanning laser polarimetry (SLP) using variable corneal polarization compensation with standard red-free photography for detection of RNFL damage in glaucoma. METHODS: This observational, cross-sectional study included 1 eye of each of 42 patients with open-angle glaucoma, 32 patients suspected of having glaucoma, and 40 healthy subjects. The RNFL measurements using SLP with variable corneal compensation were obtained within 3 months of red-free photographs. Two independent observers graded RNFL photographs using a standardized protocol. Superior and inferior hemiretinas were scored separately, and a global score was obtained by averaging scores from each hemiretina. MAIN OUTCOME MEASURES: The RNFL photography scores were compared with RNFL thickness measurements obtained with SLP. The receiver operating characteristic (ROC) curves were constructed to assess the abilities of the different methods to differentiate glaucoma patients from healthy subjects. RESULTS: The RNFL thickness decreased with increased RNFL damage as assessed by photographs in both hemiretinas (R(2) = 15%-47%). The area under the ROC curve for the best SLP parameter, Nerve Fiber Indicator, was significantly greater than the area under the ROC curve for the global RNFL photography score (0.91 vs 0.84, P =.03). CONCLUSIONS: A moderate correlation was found between RNFL thickness measurements obtained with SLP and RNFL scores from red-free photographs. Compared with semiquantitative RNFL photography scores, the best SLP parameter had a higher diagnostic accuracy to separate glaucoma patients from healthy subjects.

Aged↗

PubMed1988

Use of circularly polarized light in fundus and optic disc photography.

Circularly polarized light was used in fundus and optic disc photography to reduce reflected glare and photographic artifacts originating from the ocular media and the lenses of the fundus camera. A standard fundus camera was used, with circular polarizers placed in the illumination and observation paths. The quality of fundus photography was improved significantly in eyes with intraocular lenses, cataract, vitreous haze, or high myopia as well as in normal eyes, in fundus photography of the retinal periphery, and in optic disc photography.

Fundus Oculi↗

PubMed2005

[Outer form and internal disease: clinical photography in the late 19th century].

Clinical photography in the late 19th century aimed at unveiling the hidden processes invisible to the clinical eye. Changes in the outer form hinted at deeper lying causes, and decoding these forms was supposed to extend the range of the clinical eye in to the realm of invisibility. Two suppositions supported this hope: the belief that each disease as an ontological entity showed typical exterior signs which allowed a diagnosis at sight, and the technological trust in photography as a precise and objective means of representation superior to the human eye. For a short time, clinical photography seemed to be the 'via regia" of diagnosis. Heinrich Curschmann's Klinische Abbildungen and Ludwig Jankau's periodical Internationale medizinisch-photographische Monatsschrift marked the climax of this development in Germany. Röntgen's discovery and its immediate application in clinical medicine put an end to the optimistic expectations: clinical photography was from now on only one among many different means of documenting clinical signs and findings.

Anatomy↗

PubMed2005

[Diagnostic value of nerve fibre layer photography in glaucoma].

PURPOSE: Primary open-angle glaucoma is characterized by a loss of retinal nerve fibres. The aim of our present study was to evaluate the diagnostic value of retinal nerve fibre layer (RNFL) photography as a routine examination for the early diagnosis of glaucomatous damage. METHODS: Between 1991 and 2000 we monitored 96 patients with ocular hypertension in a prospective study. RNFL photography was performed in 91 subjects. These photos were evaluated by two independent observers. RESULTS: The mean image quality of the photos was mediocre. The correlation coefficient for the intraindividual reproducibility (image quality) was 0.713-0.863 (Kendall's coefficient). For the interindividual reproducibility the correlation coefficient was 0.541-0.581 (Somers' coefficient). Regarding the evaluation "RNFL defect yes/no", the correlations were better but there was a discrepancy between the observers. CONCLUSION: Quality, reproducibility and prognostic value of RNFL photography were disappointing. Although RNFL photography may be convincing and informative in several situations, it is not efficient as a routine technique for the early diagnosis of RNFL damage in glaucoma patients.

Aged↗

PubMed1995

Polarized light photography in the evaluation of photoaging.

BACKGROUND: The clinical characteristics of photodamaged skin, such as coarse and fine wrinkling, sallowness, hyperpigmentation, tactile roughness, laxity, and erythema, are not accurately evaluable from photographic records. OBJECTIVE: The purpose of this study was to develop accurate and reproducible photographic techniques that generate an evaluable record of the characteristics of photodamaged skin. METHODS: The method used involved illumination and photography through polarizing filters (polarized light photography). RESULTS: Polarized light photography generates images that selectively enhance either the surface features or the subsurface features of the skin, providing an accurate and evaluable record for evaluation of photodamaged skin. CONCLUSION: Polarized light photography, when coupled with precise framing and mapping, yields an accurate and evaluable record of photodamaged skin.

Humans↗

PubMed2006

Ultraviolet fluorescence photography to detect early sun damage in the eyes of school-aged children.

PURPOSE: To develop a method to detect precursors of ocular sun damage using ultraviolet fluorescence photography (UVFP). DESIGN: Observational cross-sectional study METHODS: settings: Preschool, primary, and high school in Sydney, Australia. study population: 71 children ages 3 to 15 years old (both eyes). Inclusion criteria were children attending the schools who gave consent. There were no exclusion criteria. observation procedures: UV and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. main outcome measures: Presence of areas of increased fluorescence detected by UVFP, or presence of pinguecula detected by standard photography. RESULTS: Established pingueculae, on standard photography, were seen in seven of 71 (10%) children; all were 13 years of age or older. On UVFP, all of these pingueculae demonstrated fluorescence. In total, 23 of 71 (32%) had increased fluorescence detected on UVFP, including the seven of 23 (30%) with pingueculae. Of the remaining 16 of 23 (70%), the changes were only detectable using UVFP. Fluorescence on UVFP was seen in children ages 9 years and above, with prevalence increasing with age. The presence of fluorescence (in at least one region) was 0 of 15 (0%) for children ages 3 to 5 years, 0 of 12 (0%) of children ages 6 to 8 years, 6 of 23 (26%) for those ages 9 to 11 years, and 17 of 21 (81%) of those ages 12 to 15 years. CONCLUSIONS: We hypothesize that the areas seen to fluoresce on UVFP but not detectable on control photography represent precursors for ophthalmohelioses. Our preliminary data strongly suggests that UVFP is a sensitive method for detecting early ocular sun damage occurring many years before clinical manifestations.

Adolescent↗