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Interview with Dr. Rychjohn

1) Please describe what the Retinal Camera is used for and a basic sense of how it works.
1) The retinal camera is used to take photographs of the back of the eye or retina, which is the neurosensory tissue in our eyes that translates the optical images we see into electrical impulses that our brain understands. A fundus camera is a specialized low power microscope with an attached camera. The retina can be photographed directly through the pupil, which is used for both an entrance and exit for the cameras illuminating and imaging rays. 
2) What components, or how much of the retina, does the Retinal Camera look at and give imaging for?
2) The normal angle of view that a retinal camera is able to photograph is 30-50 degrees, which is classified as the posterior pole of the retina. Ocular structures within this area, other than the retina, include the optic nerve, macula, and retinal blood vessels. If there is a retinal lesion noted on examination that is more mid peripherally,  the technician can then have the patient look in the direction of the lesion and photograph further out if required.
3) What types of eye diseases and disorders can be discovered?
3) Many eye diseases can be discovered with fundus photography. Glaucoma, macular degeneration,  retinal vascular diseases such as diabetic and hypertensive retinopathy, optic nerve swelling, as well as chorioretinal lesions, such as choroidal nevi are of the most common and frequent eye conditions documented with photography.
4) What is it about this particular technology that you find most exciting; the component that made you feel you need to invest in this for your practice?
4) The most exciting part of this technology is the patient education component of the photography. It is extremely valuable to be able to show  patients their eye condition, so that they can better understand what we are monitoring and/or treating. As a practitioner, it is beneficial to be able to document eye conditions through photography, so that it can be compared at subsequent exams to be able to pick up on any subtle or large changes that may have occurred since their last assessment. It can also be helpful when reviewing retinal findings with a colleague.
5) Why did you choose this particular equipment from this supplier?
5) We chose the Cannon retinal camera as we felt it possessed excellent camera optics to be able to obtain accurate retinal detail required for superior patient care.
6) Can you describe the patient experience when using the Retinal Camera?
6) The patient experience is one a of a bright camera flash. One would sit at the camera with their chin in a chin rest and forehead against a bar, and maintain focus at a fixation target. The technician then focuses and aligns the fundus camera, where then a flash fires when the photographer presses the shutter release.
7) Do the patients appreciate the upgrade in technology?
7) The patients definitely appreciate this technology, as most find it very interesting to be able to visualize the back of their eyes to allow them to understand their eye condition or simply show them that their eyes are healthy, especially if they have family histories of certain eye diseases that they are concerned about.
8) How does this technology improve comprehensive eye exams compared to the days when we did not have a Retinal Camera in the optometric office?
8) Retinal photography definitely improves comprehensive exams compared to when we did not have this technology. The greatest factor that is appreciated, is the ability for us as practitioners, to be able to monitor accurately for subtle changes and look back over time with previous images to help us decide if, how much and what rate of change has occurred. This allows us to formulate an appropriate treatment plan for the patient.  With previous chart recording alone, it proved to be subjective, with differences from practitioner to practitioner, which made it more challenging to know with confidence if there was a change in one's condition.
9) For which patients do you recommend using the Retinal Camera?
9) We recommend photography on all patients over 40 years of age at every examination, as this is when risk increase for eye diseases. We also photo document any patient, regardless of age, if we are suspicious of or they have eye disease that requires monitoring to assess progression.  This would include diabetics, high myopia, hypertensive patients, patients taking high risk medications that can effect the retina, such as Plaquenil, headache symptoms that may indicate optic nerve swelling, and choroidal or retinal lesions.
10) Can you share a particular story in which, by using the Retinal Camera, you were able to detect and treat a disease that would have otherwise gone undetected?
10) I will share a recent story of one of my colleagues where fundus photography was an integral part of what determined the treatment of a patient. A larger Choroidal Nevus was noted on routine eye exam of a returning elderly patient to our clinic. The practitioner looked back on previous fundus photography and the Nevus was definitely not present on any of the previous images, therefore confirming that this was a new lesion. This is significant, as it is extremely rare to see a new choroidal nevi on an older individual, therefore leading to suspicion of a possible malignant nature of. It is currently being watched very closely and if change is confirmed, I would suspect, investigations for possible metastasis from other origins in the body may be investigated.