As a retinal sub-‐specialist , Dr Christolyn Raj performs the following consultations ad clinical treatments in her clinics on a daily basis .
Diagnostic Retinal Procedures
Ocular coherence angiography (OCT) and fundus auto-‐fluorescence
Many of the retinal referrals I receive from optometrists are often accompanied with an OCT or fundus imaging. I can’t re-‐iterate how useful this is. In our retinal clinics , the initial assessment by our team of orthoptists includes fundus digital imaging with Optos , OCT and fundus auto-‐fluorescence. However it is always useful to have baseline imaging to compare with that will become part of the patient’s history. Digital imaging in this respect is also encouraging for patients to help illustrate the disease process and improvement with treatment.
Fundus fluoroscein angiography (FFA)
Recent Medicare guidelines advise that treatment with intra-‐vitreal injection may now occur without the need for a mandatory retinal angiogram .
This has been met with mixed responses in the retinal world. An FFA does carry with it risks including allergy , anaphylaxis and rarely cardiovascular issues .This can be confronting and if an FFA is not required to demonstrate the disease process , it is often best avoided especially in our elderly in our patients.
However in many cases an FFA can offer a diagnostic clues s to better understand the underlying disease process and ultimately decide upon which treatment will be most beneficial for the patient.
In my retinal clinics this procedure is performed in accordance to strict guidelines , supervised by trained clinical staff and with adherence to strict protocols with medical emergency protocols at close hand.
Retinal Laser Treatment
Retinal laser still remains one of the most useful treatments for a number of retinal diseases from diabetes to retinal vein occlusions as well as others include retinal tears/holes.
Like many procedures retinal laser can be a daunting experience for patients and they will often need pre-‐treatment counselling and provision of a clear treatment plan.
In general retinal laser treatments are often done over a number of sessions and often with analgesia to ensure that there is no discomfort during or after the procedure.
Please refer to the patient education handout for specific information you can pass onto your patients.
Intra-‐vitreal injection Procedures
Intravitreal injections have revolutionized the treatment of retinal diseases in particular that of age related macular degeneration (ARMD) . In years past patients who developed neovascular ARMD went onto develop the devastating sequelae of fibrotic scar formation and irreversible blindness. Intra-‐vitreal injections now allow some promise to this disease with the greater proportion of patients able to maintain or improve their vision. The greatest prognostic factor being the presenting . In general as intravitreal injections help in the maintenance of the vision , they therefore must be continued on a monthly or bi-‐monthly basis depending on the clinical course.
I spend time with my patients who are to receive this treatment to inform them of the background to the disease , the role of the chosen treatment strategy and their likely prognosis. In addition to this counselling , patients also receive an
‘intravitreal -‐injection kit’ containing important information on post-‐injection aftercare , written information on their disease and the drug that they are being treated with. There is often also information on a support network for patients and carers who need to be aware that this is a long-‐term management strategy.
Neonatal screening for Retinopathy of Prematurity (ROP)
Neonatal screening for ROP occurs statewide . In many centres initial screening is performed by an Ophthalmologist with specific training in management of ROP . It some centres registered nurses are able to take retinal photographs of some babies with “Retcam” that are then assessed by the Ophthalmologist. Babies that are within the ‘at risk’ criteria for ROP include those born at <27weeks gestation and of birth weight <1500g and/or exposed to supplemental oxygen in the neonatal period. Should these neonates require treatment , often in the form of retinal laser and/or intra-‐vitreal injection , they are often transported to the Royal Children’s hospital for treatment under sedation.