DRS workshop

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DRS workshop

• Technical failures/slit lamp examination
• 4th November 08

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Topics

• Image quality / clarity
• Dilatation Tropicamide
• - dilatation protocol
• - contraindications
• Glaucoma
• Cataract
• One eye only
• Slit lamp examination

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Image quality definition

• An image with visible referable retinopathy or
  maculopathy is always an adequate image
• An image that has adequate quality for grading
  has both adequate field definition (has the
  correct area of retina been photographed?) and
  adequate clarity (would referable retinopathy
  and maculopathy to be identified, if present?).

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Image quality definition

• An image with adequate field definition displays
  the intended macula-centred 45 portion of the
  retina.
• The entire optic disc must be displayed.
• The fovea must be at least 2.0 DD from the edge
  of the image.

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Image clarity

• An image with adequate image clarity allows
  referable retinopathy and maculopathy to be
  identified, if present.
• The third generation vessels radiating around the
  fovea must be visible.

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Image quality If referable retinopathy than it
is gradable
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Dilatation

• Improves the quality of image
• Decreases the technical failure rate
• If image still not good then Slit lamp
  examination
• Main cause of Tech failure is cataract

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Tropicamide

• Scottish DRS Programme the normal mydriatic is
  Tropicamide 1.0.
• The Medicines and Healthcare products Regulatory
  Authority (MHRA) has agreed the legal basis for
  the administration of eye drops by the National
  Screening Programme for Diabetic Retinopathy
• Tropicamide is muscarinic acetylcholine receptor
  blocker, (anti muscarinic )
• short duration of effect (48 hours),

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Dilatation protocol

• Explain The reason for administration
• Explain sting slightly, temporary blurring of
  vision
• Explain not advisable to drive within several
  hours
• If the patient declines,make another
  appointment, attempt photography
• Give the patient the eye drop information leaflet

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Tropicamide

• Ensure the patient is seated comfortably with
  their head tilted back slightly
• Confirm the correct drop/strength
• Check expiry date and record batch number
• Gently pull down the lower lid and ask the
  patient to look upwards. Instil two drops into
  the eye above the lower lid. Offer the patient a
  tissue to dry their eye.
• Limit risk of infection by using appropriate
  infection control procedures

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Preservative free drops
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Contraindications

• Allergy if known , rare
• Preservative free drops
• Patients with contact lenses - remove
• Glaucoma is not a contraindication to mydriasis.
• Risk of acute angle closure glaucoma is minimal
  using this drug

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Glaucoma

• Open angle glaucoma common
• No risk of pressure going up with mydriasis
• Closed angle glaucoma if patients knows about
  it then it has been treated
• Safe to dilate
• Risk of precipitating ACG by dilatation very rare
  

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Acute angle closure attack
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Laser iridotomy
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Treatment of ONG

• Drops - timolol, xalatan, Alphagan etc
• Surgical with an operation
• trabeculectomy

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Rubeosis irides
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Obtain images
Both images gradable Save images
One image ungradable
History of blind in one eye e.g. NPL
No history of poor vision e.g. both eyes gradable
in previous year
Delete ungradable image
Save both images
Save gradable image only
Technical failure for slit lamp
Make note in patient history to re-photograph
right/left eye only next year
Story of one eye patients
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Slit lamp examination

• Not a easy skill to learn
• Learn to use the slit lamp How to seat the
  patient yourself
• Examine the anterior segment
• Learn to use the lenses
• View the retina
• Orientation on retina

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Chairs with adjustable height
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Seat patient comfortably
Forehead against the bar Eye level Hands on bar
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Examine the anterior segment
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