Retinal imaging explained—and health conditions it can ...

In our latest interview with EyeMed’s medical team, Dr. Lahr and Dr. Neighbors, we discuss retinal imaging and its benefits. Here’s what we learned. 

"We get lots of questions about retinal imaging. What is it? Why is it so important? And why isn’t it covered as part of an eye exam?”

Your eye is only about 1 inch across. Yet it’s one of the most complex organs in your body. To help providers see your inner eye more clearly, a retinal image can be critical.

A retinal image sees up to 5 times more than a traditional undilated eye exam. Plus, a retinal image is an important historical baseline that allows providers to compare images year-over-year so that conditions can be managed and treated.

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What exactly is a retinal image? 

Retinal imaging is a high-resolution image of the inside of your eye. Included in the image is a detailed view of the retina, optic nerve and retinal blood vessels—all of which can show signs of underlying eye and general health issues. 

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How is a retinal image captured? 

‌A retinal image is quick and painless. The patient sits comfortably in a chair and places their forehead and chin on the camera device. Nothing touches the eye during retinal imaging. A quick flash of light, and the image is captured in real-time.

What can be diagnosed through a retinal image? 

Retinal imaging is a non-intrusive way to see the early signs of vision and health conditions:

• ‌Cataracts
• Glaucoma
• Diabetic retinopathy
• Macular degeneration
• Some forms of eye cancer
• Diabetes
• Hypertension
• High cholesterol

Do you need pupil dilation with retinal imaging? 

Pupil dilation allows observation of the peripheral retina. However, dilation is not always convenient for patients due to the side effects— blurry vision and light sensitivity—for several hours after the exam. Retinal imaging allows the same view of the peripheral retina without pupil dilation and the undesired side effects.

So why can’t retinal imaging be added to the components of a comprehensive eye exam and avoid the added out-of-pocket cost?

‌What would seem simple is actually very difficult and challenging. Eye exam service code definitions, which include the test components, are controlled through copyright by the American Medical Association. If you think new codes are easy to create, think again.

EyeMed introduced Retinal Imaging 7 years ago and the popularity of this screening test has continued to grow. Currently, the median acceptance rate for Retinal Imaging is 65%.

Meet the experts: Medical Directors, Drs. Lahr and Neighbors

Dr. John Lahr, O.D., FAAO           Dr. Andrew Neighbors, O.D.

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For more information, reach out to your EyeMed representative or visit eyemed.com. 

How is retinal imaging performed?

There are three main methods that eye care specialists use to take digital pictures of your eye’s fundus (the inner, back surface of your eye). These include:

• Color fundus photos. Fundus is another term for the back of the eye. Providers have used fundus cameras for decades to take pictures inside your eye. You’ll see bright flashes of light while the camera takes pictures. Advances in technology allow precise digital retinal images in high resolution. Some cameras can also take wide-field views of your fundus, allowing your eye care team to see a larger area of your retina. One strength of this imaging method is its ability to show your blood vessels and reveal signs of diabetes-related retinopathy.
• Optical coherence tomography (OCT). This is a common imaging test your provider may perform to see cross-sectional views of the layers of your retina in the macula region and optic nerve. This method can show each layer of your retina and measure how thick it is. It can help diagnose conditions like diabetes-related macular edema and macular degeneration.

In all these cases, you sit comfortably in a chair and move your face close to the camera device. Your provider shows you where to place your forehead and chin. Nothing touches your eye during retinal imaging.

Providers sometimes use one or more of the above methods at the same time. They may also use one of the methods along with fluorescein angiography. This technique is minimally invasive. Nothing touches your eyes, but your provider injects a dye into a vein in your arm. This dye travels through your blood vessels, including those in your eyes. It reveals blockages or other problems in those vessels.

What happens before the test?

Your provider will tell you about the procedure and why you’re having it. They may ask you to give consent.

Providers usually put drops into your eyes to dilate your pupils. That’s because your pupil is the window that the camera sees through to capture pictures of your fundus. A wider pupil typically leads to better images. Make sure you arrange for someone to drive you home. Your vision will be blurry, and you’ll be sensitive to light for a few hours after pupil dilation.

What happens during the test?

Retinal imaging, including fundus photography and OCT, is fast and painless. Here’s what you can expect:

1. You’ll sit in a chair in front of the imaging device. Your provider will make sure you’re comfortable.
2. You’ll position your face so your chin rests comfortably in a chin rest, and your forehead presses gently against a bar.
3. Your provider will align the camera and begin taking photos. They’ll capture images of one eye at a time.
4. You may need to focus on a green light. The light may be bright and cause brief discomfort as you look at it.
5. Your provider will tell you when you can sit back from the camera.

Retinal imaging typically takes five to 10 minutes. If your provider uses fluorescein angiography, the process may take up to 30 minutes.

What can I expect after the test?

If your provider dilates your eyes, you’ll have blurry vision and sensitivity to light for a few hours. So, give your eyes a rest. Don’t drive, read or look at screens. Wear sunglasses to protect your eyes when you’re outside.

What are the risks of retinal imaging?

Retinal imaging, including fundus photography and OCT, is safe with no known risks. Your provider simply uses a camera to create digital images of your eyes.

Fluorescein angiography is low risk but may cause side effects like temporary skin discoloration (a slight yellow tint) or urine that appears dark yellow to orange. These effects go away within 24 hours.

Rarely, fluorescein may cause an allergic reaction (hives or itching). The risk of anaphylaxis is extremely small. People who are sensitive to fluorescein may experience:

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• Dizziness.
• Dry mouth.
• Increased heart rate.
• Metallic taste in their mouth (brief).
• Nausea or vomiting.
• Sneezing.