Fully equipped and modern facilities to provide the best care for your eyes

Many of our patients are accustomed to seeing an image of their eyes as part of the eye examination. We have been using the ‘retinal’ camera for 15 years now. There was a bedding-in period when we first got the camera where we were trying to evaluate how useful it was. Experience showed that it helped us to raise our game and become better clinicians. We found that with certain patients it identified changes that we would otherwise not have seen, despite taking care and time.

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After we had used the camera for a few years, we realised that the ability to compare back to an image, rather than the limited review type notes that all opticians had relied on previously, helped us to identify change earlier and monitor more accurately.

 

 

In 2006 we upgraded the camera as technology had move on. More defined images were possible with the newer more modern cameras with ever more pixels.

OCT_equipmentThe OCT machine has just created another HUGE jump in our ability to observe the eye. In just 3 seconds the machine scans the back of the eye and then takes a retinal image, like the old camera but with an even greater resolution. We have chosen this OCT machine as it is the only one to be able to relate an image of the retina – like the one you are probably used to seeing – to what looks like an MRI type scan of the back of the eye. It is totally painless and the light is less bright than our present camera.

Please see our video on OCT and photography to help understand more.

The OCT scan enables us to observe your eye in a completely new way. It gives depth to our image and the ability to separate the different layers at the back of the eye. In general, better decisions are made when better information is available. With the increased quality and quantity of information achieved with the OCT we are empowered to do an even better job.

 

Four areas where the machine has particular benefits are:

This is a change that happens to everyone’s eyes as they age. Normally there are no signs before the age of 60, and they typically increase as we get older. If the changes are more marked than normal, we classify them as macular degeneration. In most cases, as they are due to an ageing eye, they are called Age Related Macular Degeneration (AMD for short). There are two types, wet and dry.

Dry is generally an insidious slow progression that is often classed as ‘wear and tear’. Little help is possible although lifestyle and diet can be optimised to minimise change.

The wet type has generally much faster changing symptoms and more damaging effects. With this type of AMD quick review is necessary. Fortunately the last 2 years have seen marked improvements in the ability to help new cases of this type of AMD. The monitoring of these changes, and the differentiation between the two types, is taken to a whole new level with this instrument.

This is a blinding disease affecting the nerve layer at the back of, and leaving, the eye. The OCT can measure the thickness of the nerve layer, monitor progression in thinning, and compare against the normal database in the instrument (which takes into account age, sex and ethnicity). Having exact measurements to compare against is invaluable in becoming aware of early slight changes. That enables treatment to start before so much damage is done to your vision that you notice the problem.

We are always very aware of the pressure in the eye, as this is the most common cause of the problem. But over the last few years we have realised that the old way of measuring the pressure is not as standardised as we thought. We measure the pressure in any vessel by seeing how easy it is to indent (think of trying to press in the surface of a golf ball compared to a tennis ball). The front surface of the eye, the cornea, varies in thickness from person to person and if it is thicker than normal will give a higher reading than true and if thinner will give a lower reading.

The OCT can measure the corneal thickness giving us a truer idea of the pressure. This offers some reassurance in cases where a higher value is found in conjunction with a thick cornea or heightened awareness in the case of a thinner cornea. This measurement would only need to be taken once as the thickness of the cornea rarely changes.

This condition often compromises the blood circulation in the body. So the eye is an excellent place to examine the vascular condition without being invasive. For this reason all diabetics have a retinal check at least annually.

For the last 12 years we have been using a retinal camera for this. For the last 8 years the NHS has recognised it as the best way of monitoring and so has started to fund retinal photography for diabetics. Our OCT machine takes an image as part of its function. We can then also compare sections of the image to get a more in depth analysis of the exact state of the retina at that point.

We feel this offers benefits over the NHS based systems. However it does not have the advantage of the majority of the images being reviewed by another optician, as is the case with the NHS system, nor is it tied into the NHS reporting system that is part of the NHS Vector system.

For all diabetic patients in appropriate NHS catchment areas we would still use our old camera and the Vector system that has been developed by the NHS. This would still be at no charge to the patient. The OCT, if requested, would be charged privately and done in addition to the NHS system. It would give us an advantage also of having a set of more in depth details about your eyes should the NHS change its choice of image capture, using hospitals or local health centres instead, in which case we would probably no longer have access to the older images for comparison.

The main chamber inside the eye is filled with a jelly like substance called the Vitreous Humour. In all eyes this degenerates with age, starting to develop fluid like areas within it and leaving small deposits which we often recognise as moving black specks called (vitreous) floaters. The shrinking of the vitreous that occurs with age frequently causes the vitreous to pull away from the back of the eye, at this point people often notice a flashing light appearing in the vision.

In most cases this causes no problem, other than noticing the floaters. But at times it is so strongly connected to the retina that it causes a tear or pulling off of the retina. The OCT enables us to see exactly how the vitreous is attached to the retina in the central area and point out any areas of traction that could cause problems. The machine does not cover the outside of the retina where a lot of tears can take place and so is not used in a stand-alone capacity. But is a very useful tool as part of our fact finding when examining the eye for vitreous changes.

 

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During early 2018 we brought yet another new instrument into our practice. The new instrument is called the Optomap. This helps us do a better eye examination. It is a camera that dramatically increases how much we can see of the back of your eye.

For the last 18 years we have been regularly using a fundus camera, we were early adopters to this technology then and it has now become fairly commonplace, in fact a few of the bigger companies are making quite a point of their using what they term “new technology”. Fundus cameras show us the central 45 degrees of the retina (the layer at the back of your eye), the Optomap shows us 200 degrees in one panoramic image with incredible definition, helping us to spot diseases and problems earlier so they can be attended to earlier hence we can optimise long term outcomes. Spending extra time and showing you, our patients, the Optomap images allows you to see what we see and discuss them with you. One of the greatest benefits of the Optomap is the ability to digitally save the images, allowing us to compare the images at future examinations.

Because we are so sure it is the best way to examine, and keep records to compare against in the future, we have invested time and over £60,000 on the machine and now privately offer examinations that include this technology. Once again, we are showing our commitment to your care. As at March 2018 it is estimated that less than 5% of opticians in the country have one of these instruments. We look forward to showing you the results.