In recent years, greater emphasis has been placed on the early detection of diseases at the primary healthcare level. Eye diseases such as diabetic
retinopathy, age-related macular degeneration and glaucoma are the leading causes of blindness in Singapore and worldwide. These conditions can be detected with fundus photography – the perennial conservative tool for ophthalmic diagnosis.
Fundus photography has an edge over the direct ophthalmoscope as the latter needs a greater skill to perform and allows only a limited view of the fundus at a time. In addition, with direct ophthalmoscopy, there is no means of keeping a record, other than through manual drawing. On the other hand, fundus photography offers means of capturing wider-view digital images of the fundus.
With newer technology, fundus images can be captured without dilating the pupils, thus eliminating the need for assessing the suitability of dilating the pupils and the risks associated with pupil dilation such as acute angle-closure glaucoma.
While the fundus camera can be operated by technicians, the interpretation of images acquired require some knowledge, skills and experience. The doctors in National Healthcare Group (NHG) Eye Institute, together with a senior optometrist, have compiled a user-friendly guidebook on the interpretation of fundus photography for use by primary care professionals. This is believed to be first of its kind locally.
One of the challenges in the interpretation of fundus photography is the wide variety of normal fundi seen in our local population. The appearance of fundus may be affected by age, race, degree of myopia and other factors.
We have compiled a wide range of normal fundi and provided guidelines on subtle changes to watch out for in diseases such as glaucoma, macular pucker and diabetic maculopathy.
Other highlights of the book include advice on choice of fundus camera, practical tips on its use and possible artifacts. Case studies of real-life scenarios in optometric practice are included as well.
Presently, there is a national effort to provide centralised online reporting of fundus images by trained personnel and optometrists. It is hoped that with this book, more primary eye care professionals will perform fundus photography as part of the eye disease detection and join the fight for blindness prevention.
Dr. Lim Boon Ang
Dr. Lim Boon Ang is a Senior Consultant at the National Healthcare Group Eye Institute @ Tan Tock Seng Hospital. She received her cataract and glaucoma training at the Sydney Eye Hospital/Save Sight Institute in Australia. She is a champion for patient education and training of primary eye care professionals including general practitioners and optometrists.